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1. A COMPARISON OF PARIETAL AND
ILLIAC CREST BONE GRAFTS FOR
ORBITAL RECONSTRUCTION
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. 
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Blowout # of the orbit most commonly involve the
floor & medial wall.
The displacement of the wall can have serious sequelae
regarding function & appearance of the eye.
In general , the volume of the orbit will change relative
to the displacement of one or more walls.
If the volume of the orbit relative to the volume of the
intraorbital soft tissue contents the globe will sink
inward & possibly downward.
If the volume of the orbit is reduced it will project
outward & possibly upward.
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3. 
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Several theories have seen proposed to explain the
effect of trauma on the orbit.
In the hydraulic theory, a hard object strikes the soft
tissue of the orbit & transfers pressures from these
tissues to the orbit walls. The thinner walls then open
like a trap door into an adjacent sinus, & the soft tissues
are pushed through the defect.
In another theory –BUCKLING THEORY, a force to
the orbital rim causes the orbital wall to buckle,
deforming them & the soft tissues.
Despite the long term results of orbital reconstruction ,
there are cases in which the long term results &
cosmetic outcomes may be different than after
immediate postop.
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4.  It is suggested
that membranous bone grafts
significantly under goes less resorption than the
endocondral bone grafts when applied to the
craniofacial skeleton & that membranous bone
grafts should be used preferentially.
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5. PATIENTS AND METHODS
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From 1983 -1997--- 25 orbital reconstructions in 22 pts
repaired with autogenous bone grafts were able to be
evaluated.
Follow up was scheduled for 1,2,3,6 & 12 months &
measurements were obtained & recorded for as long as
pts participated in the follow-up period.
Of the 25, parietal bone graft is placed for 9 & 16 for
iliac crest bone grafts.
Illiac bone were used preferentially for larger defects.
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6. 
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All pts received grafts to the inferior wall, some had
graft for the posterosuperior lat wall.
Pre op & post op enophtalmos were measured using
corneal projection with a Hertel exopthalometer & ruler
ruler referenced to the lat orbital rim.
Pre- & post op hypophthalmos, exophthalmos &
diplopia was evaluated subjectively in 3 gaze of fields.
Post surgery measures were scheduled for 1,2,3,6 & 12
months.
Best values were between 3 – 7 months since by that
time swelling would have been reduced & calues had
been largely stabilized.
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7. RESULTS
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There were 15 males & 7 females of total 25 #
reconstruction. Age ranged from 19 – 57.
Time initial injury to surgery ranged from 1 – 20
months, with a median of 4 months for cranial & 8
months for illiac graft.
period of evaluation for cranial bone is 4 – 54 months
& for illaic bone is 4 – 51 months .
For cranial grafts the mean & SD showed 1.78 ± 1.20
mm, illic bone 1.37 ± 1.53mm.
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8.  Comparison of pre & post op showed that illiac
bone graft has greatest reduction.
 In enophthalmous- cranial group ,7 to 9
surgeries were successful, for illiac 15 of 16 were
successful.
 Hypohthalmous was difficult to evaluate because
of statistical analysis.
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9. Discussion
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Several authors have reported that free endocondral
bone placed on the craniofacial skeleton resorb to a
greater extent than free membranous grafts.
Membranous bone graft maintain their volume better
that endochondral bone graft when grafted on the
rabbit snout.
Membraneous bone tend to have a thicker cortex & a
denser, thinner cancellous layer than endocondral bobe
graft.
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10. 
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Another important factor is the resorption in the
method of fixation of the graft. Movement of the graft
tends to decrease viability , & it is believed that rigid
fixation of the onlay bone grafts will decrease
resorption.
It si also important to determine which factors were
operationally important in the apparent lack of
resorption of these grafts.
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11. Thank you
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