Abstract
Various grafts with autogenous bone, cartilage, and alloplastic substitutes have been used for orbital floor reconstruction in surgery of facial fractures. Nevertheless, none has been the gold standard of graft material. We have demonstrated good clinical results in cases of pure blowout fracture in which the orbital floor was reconstructed with iliac cancellous bone sheets used as graft material. Here, we detail our surgical technique for orbital floor reconstruction with iliac cancellous bone.
The outline of our procedure is as follows:
1)to approach the orbital floor, mainly the subciliary incision is used,
2)the orbital content herniating into the maxillary sinus is repositioned, and the fracture and defect site are exposed subperiosteally,
3)a bone block, a few millimeters thick, is harvested from the inner aspect of the ileum,
4)the cortical bone of the harvested block is burred away and thinned to about a 1 mm-thick cancellous bone sheet,
5)the sheet can be adequately trimmed with surgical scissors,
6)the sheet is placed onto the orbital floor to cover the defect, without any fixation.
The iliac cancellous bone graft is as pliable and flexible as to fit the delicate curve of the orbital floor, and as soft as to cut easily with surgical scissors. We consider it the most appropriate material for orbital reconstruction.
