Reconstruction of Orbital Floor Fracture Using Solvent-Preserved Bone Graft Reha Yavuzer, M.D., Serhan Tuncer, M.D., Yavuz Bas ¸terzi, M.D., I ˙ pek Is ¸ik, M.D., Alper Sari, M.D., and Osman Latifog ˘lu, M.D. Ankara, Turkey The orbital floor is one of the most frequently damaged parts of the maxillofacial skeleton during facial trauma. Un- favorable aesthetic and functional outcomes are frequent when it is treated inadequately. The treatment consists of spanning the floor defect with a material that can provide structural support and restore the orbital volume. This ma- terial should also be biocompatible with the surrounding tissues and easily reshaped to fit the orbital floor. Although various autografts or synthetic materials have been used, there is still no consensus on the ideal reconstruction method of orbital floor defects. This study evaluated the applicability of solvent-preserved cadaveric cranial bone graft and its preliminary results in the reconstruction of the orbital floor fractures. Twenty-five orbital floor fractures of 21 patients who underwent surgical repair with cadaveric bone graft during a 2-year period were included in this study. Pure blowout fractures were determined in nine patients, whereas 12 patients had other accompanying maxillofacial fractures. Of the 21 patients, 14 had clinically evident dip- lopia (66.7 percent), 12 of them had enophthalmos (57.1 percent), and two of them had gaze restriction preopera- tively. Reconstruction of the floor of the orbit was performed following either the subciliary or the transconjunctival ap- proach. A cranial allograft was placed over the defect after sufficient exposure. The mean follow-up period was 9 months. Postoperative diplopia, enophthalmos, eye motility, cosmetic appearance, and complications were documented. None of the patients had any evidence of diplopia, limited eye movement, inflammatory reactions in soft tissues, infec- tion, or graft extrusion in the postoperative period. Provid- ing sufficient orbital volume, no graft resorption was de- tected in computed tomography scan controls. None of the implants required removal for any reason. Enophthalmos was seen in one patient, and temporary scleral show lasting up to 3 to 6 weeks was detected in another three patients. Satisfactory cosmetic results were obtained in all patients. This study showed that solvent-preserved bone, which is a nonsynthetic, human-originated, processed bioimplant, can be safely used in orbital floor repair and can be considered as another reliable treatment alternative. (Plast. Reconstr. Surg. 113: 34, 2004.) The orbital region is the most important aesthetic and functional unit of the facial skel- eton, and orbital fractures should be consid- ered seriously. Blowout fractures following blunt trauma to the bony orbit require accu- rate diagnosis and appropriate management to avoid undesirable early and long-term compli- cations, such as diplopia, enophthalmos, dys- topia, restriction of eye movement, and im- paired facial appearance. 1 The goal of management is to restore the original anatomy of the orbit. Either isolated or in combination with other maxillofacial fractures, orbital floor defects should be reconstructed by using one of the recommended materials to restore the continuity of the bony orbit. Although various autografts or synthetic materials for orbital floor defects have been used, there is still no ideal reconstruction method. 2–8 Any material used to span the defect should provide enough structural support and reestablish the prein- jured orbital volume. It should also be biocom- patible with the surrounding tissues and easily reshaped to fit the orbital floor. 2,3 Calvarial, iliac, split costal bone, and cartilage autografts have been the typical alternatives for recon- struction. 2–6 However, increased operative time, the need for a second surgical site, and potential donor-site morbidities limit the use of these autografts. 6,7 Alloplastic materials, such as porous polyethylene, hydroxyapatite, poly-L-lactic acid, polyglycolic acid, silicone, and bioactive glass, have been popularized to minimize the undesirable sides of autograft From the Plastic, Reconstructive, and Aesthetic Surgery and Pathology Departments, Gazi University Faculty of Medicine. Received for publication November 6, 2002; revised March 17, 2003. Presented at the 20th Annual Meeting of the European Society of Ophthalmic Plastic and Reconstructive Surgery, in Muenster, Germany, September 19 through 21, 2002. DOI: 10.1097/01.PRS.0000096704.34065.03 34