Autologous Cartilage Grafts Versus Collagen Membrane in Management of Small Post-Traumatic Orbital Floor Defects

Introduction: Orbital floor fractures are of the commonest maxillofacial injuries nowadays due to increased incidence of interpersonal violence and road traffic accidents. Many studies have investigated the indications and most advantageous time for surgery as well as the most favorable surgical methods for orbital blowout fractures. Cartilage is usually easier to harvest and shape and it can provide long-term support to the surrounding tissues without undergoing resorption, even after several years. On the other hand, some stated that collagen membranes are suitable for the reconstruction of defects of the orbital floor of about 1cm². Aim of the Work: The aim of this study is to compare the results of using autologous cartilage grafts with those of using collagen membrane in reconstruction of small post traumatic orbital floor defects. Patients and Methods: A randomized controlled comparative study was conducted at the Plastic and Maxillofacial Department at Cairo University Hospitals including 30 patients having orbital floor fractures associated with small orbital floor defects either isolated or with other maxillofacial fractures, coming to the outpatient and emergency services of the department from June 2012 to December 2013. Patients were subdivided into two groups, 15 cases were managed using autologous cartilage grafts for reconstruction of the orbital floor defects (Group A), and 15 cases were managed using collagen membrane (Group B). Results: All patients had a significant improvement in esthetic appearance. The injured side and uninjured side or both sides were symmetrical and well formed. Two cases (one in each group) had temporarly scleral show postoperatively and were managed conservatively. Of 16 cases presented with diplopia, 13 recovered completely during the 6 months after surgery, 2 improved, and 1 was insufficient (Group A). All patients were satisfied with their therapeutic results except the one with recurrence of diplopia. Conclusion: Autologous cartilage grafts cause no immunological problems, but there are restricted donor sites. In addition to second site morbidity related problems. Collagen membrane as a synthetic biomaterial is a good alternative and can overcome these limitations although it is expensive.