Publication:

Orbital floor fracture reconstruction using autologous bone graft: its outcome, advantages and disadvantages

Orbital floor fractures are commonly encountered facial injuries requiring precise reconstruction to restore orbital volume and prevent functional and cosmetic sequelae. This retrospective study evaluated the outcomes, advantages, and disadvantages of orbital floor reconstruction using autologous iliac crest bone grafts in 20 patients aged 18 to 60 years, all presenting with unilateral orbital floor fractures involving more than 50% of the floor or associated with diplopia or extraocular muscle entrapment. All patients underwent reconstruction within 14 days of injury. Pre- and postoperative assessments included computed tomography (CT)-based orbital volume calculations, anteroposterior globe positioning, and clinical evaluations of diplopia, infraorbital nerve function, and ocular motility. The mean preoperative orbital volume difference between the fractured and contralateral sides was significantly reduced from 5.1 cm3 to 0.2 cm3 postoperatively (p<0.001), with correction of enophthalmos achieved in 90% of cases. Diplopia resolved in 6 of 7 patients postoperatively, and infraorbital nerve hypoesthesia showed improvement in the majority. No cases of graft resorption were observed on follow-up imaging, and only one patient experienced mild, self-limiting donor site morbidity. These outcomes demonstrate that iliac crest bone grafting is a reliable and biocompatible option for orbital floor reconstruction, offering excellent anatomical and functional restoration without the complications associated with alloplastic materials. Compared to titanium mesh, previously shown to provide good radiological and clinical results, iliac bone grafts offer the added advantage of biological integration. Given its favourable safety and efficacy profile, iliac crest bone remains a valuable material for complex orbital floor reconstruction.