Comparative Study of Evaluation of Results of Orbital Floor Reconstruction with Calvarial Bone Graft Vs Sialastic Implant

Abstract

Introduction: Orbital floor fractures can result in considerable facial deformity. A vast array of autogenous and alloplastic materials are being used to reconstruct Orbital floor defects. Amongst the alloplastic materials sialastic implants are most commonly being used for orbital floor reconstruction whilst among the autogenous bone grafts calvarial bone graft are commonly used. Unfortunately no study has been conducted in Pakistan to compare the post operative results of these two commonly used materials for orbital floor reconstruction. The aim of this study is to compare the results of orbital floor reconstruction using sialastic implants and calvarial bone graft in order to find out which of the two materials shows better post operative results.
Methods: A Quasi experimental randomized trial was conducted from November 2006 to November 2007 in the department of Oral and Maxillofacial surgery, King Edward Medical University/Mayo Hospital, Lahore. A total of 60 patients were recruited over a period of 12 months. All patients were followed up at regular intervals i.e. 1 week, 2 weeks, 2 months and 6 months. The six month evaluation of Orbital floor reconstruction was done by noting the improvement in diplopia, enoph-thalmous and presence or absence of infection, extrusion, dislodgement in 30 cases with calvarial bone graft (group A) and in 30 cases with sialastic implants (group B).
Results: Approximately 44% patients presented with one of the post operative complaints of diplopia, enophthalmous and both (diplopia and enophthalmous) at the 6 months follow up in group B as compared to only 17% patients with post operative complaints in group A (p = 0.05). Post operative complications i.e. infection, extrusion and dislodgement occurred in 43.4% patients from group B as compared to 20% patients from group A (p = 0.02).
Conclusion: Reconstruction of orbital floor fracture with autogenous bone (calvarial bone) should be preferred as compared to reconstruction with the sialastic implants because of lesser post operative complications.
Key Words: Orbital floor defect, Orbital rim, Para Nasal Sinus, Computerized tomogram, Magnetic Resonance Imaging, intraocular pressure.