A CLINICAL CASE OF ORBITAL RECONSTRUCTION

A CLINICAL CASE OF ORBITAL RECONSTRUCTION M. Maglione, D. Sossi, E. Salvador, R. Rizzo Oral surgery, University Of Trieste, Trieste, Italy Objective: Blowout fractures of orbital bone may be cause of important facial asymmetry . Significant complications can occur as a result of these injuries, including enophthalmos, persistent diplopia, vertical dystopia, and restriction gaze. Recommendation for surgical fracture repair depend on a combination of clinical and imaging studies to evaluate the muscle and the nerve entrapment and periorbital tissue herniation. There are many techniques and biomaterials for reconstructing the original bony contour and restoration of proper orbital volume. Often a second surgery intervention may be required to solve the clinical case. Methods: A male 21 -year-old patient suffered frontal anterior cranial vault injuries and facial pan trauma. A first surgical intervention was performed to fracture reduction of frontal bone and zygomatic suture, supraorbital reconstruction with frozen bone, orbital floor reconstruction with durapatch membrane and reduction of maxillo-zygomatic process on the left. Reduction of frontal bone and zygomatic fracture, orbital floor and medial orbital frame reconstruction on the right. Than the patient’s anatomy was assessed in multiplanar (axial, coronal, sagittal) and 3D computed tomography. Stock titanium mesh was then preformed to the stereolitographic model to reproduce optimal orbital contour. A second surgical intervention was performed after 6 months to resolve left diplopia and the facial asymmetry of the patient. The orbital floor on the left was 7,4mm deeper than contralateral one. An orbital floor reconstruction with iliac crest graft bone was performed. A 1,5cm length and 1,2 deep graft bone was shaped and fixed with titanium mesh plate and screws. Result: Preoperative computer modeling provides useful guide for and presumably more accurate reconstruction of complex orbital injuries. Conclusions: The combined use bone grafts of titanium mesh plate could be an effective technique for the orbital floor reconstruction in severe asymmetry.