Repair of Orbital Floor Fractures Using Maxillary Bone Grafts

This study aimed to present maxillary bone grafts as a favorable option for the reconstruction of traumatic orbital floor (TOF) defects.

The senior author's preferred surgical technique using a transconjunctival incision is described. Patients undergoing TOF repair using maxillary bone grafts versus titanium mesh were then assessed retrospectively, with a focus on the size of the TOF defect, operative time, and complications.

A total of 389 patients presented with 426 TOF defects to a single surgeon between 2006 and 2021. Maxillary bone grafts were used to repair the orbital floor fracture in 304 patients (332 fractures), whereas the remaining 85 patients (94 fractures) were repaired using titanium mesh. There were no significant differences in age or sex. Orbital defect size was slightly higher in the titanium mesh group (bone graft group: mean 1.58 cm², range 0.29-2.91 cm²; titanium mesh group: mean 1.74 cm², range 0.38-2.98 cm²). There were fewer complications observed when using the autogenous bone graft substrate (10%) versus titanium mesh (18%). No major donor-site complications were documented in the bone graft group. Operative time was marginally higher in the bone graft group than in the titanium mesh group (35.9 versus 29.2 min).

This study serves as the largest clinical series to date examining indications, surgical technique, safety, and efficacy of maxillary bone grafts in TOF repairs. Maxillary bone grafts represent a viable option to be considered in the armamentarium of the craniofacial surgeon for the treatment of TOFs.