Maxillary bone grafts for the repair of traumatic orbital floor defects.

PURPOSE: To present maxillary bone (MB) grafts as a viable option for repair of traumatic orbital floor (TOF) defects by comparing their use to titanium mesh (TM) looking at TOF defect size, operative time, and complication rate. METHODS: The senior author's surgical technique is described. Patients undergoing TOF repair using MB versus TM were assessed retrospectively, focusing on TOF defect size, operative time, and follow-up results. RESULTS: One hundred ninety-six patients with 212 TOF defects presented to a single surgeon between 2004 and 2008. One hundred sixty-five patients (178 TOF defects) were repaired with MB and 31 patients (34 TOF defects) with TM. The MB and TM groups were similar with respect to age, gender, time to repair, and other associated facial fractures. TOF defect size was similar between the two groups (MB: mean 1.7 cm2, range 0.32-2.82 cm2; TM: mean 1.9 cm2, range 0.5-2.83 cm2). Follow-up was slightly longer in the TM group; however, many patients were lost to follow-up. There were no donor-site complications in the MB group and no significant difference in postoperative complications in the MB group versus the TM group (11% vs 24%). The operative time in patients with TOF defects was slightly longer in the MB group versus the TM group (35 min vs 27 minutes, p = .02). CONCLUSIONS: This series is the largest published series to date. MB was used successfully to repair TOF defects, with no increased risk of complications and only a slightly longer operative time compared to TM. MB offers an autogenous bone graft source that is technically easy to harvest and in the same surgical field, obviating many of the complications associated with alloplastic materials and traditional bone graft choices. MB grafts should be considered a viable option when choosing material to repair TOF defects.

Cervical spine injury in association with craniomaxillofacial fractures.

BACKGROUND: The incidence of cervical spine injuries associated with facial fractures varies from study to study. There is general agreement that immediate management of cervical spine injuries is mandatory to prevent further neurologic injury. Nevertheless, disagreement exists as to the actual incidence of cervical spinal trauma in conjunction with various facial fracture patterns. The purpose of this study was to review the incidence of cervical spine injury associated with various types of facial fractures presenting to St. Michael's Hospital Regional Trauma Center, Toronto, Ontario, Canada. METHODS: The authors conducted a retrospective chart review of craniomaxillofacial fracture patients presenting to St. Michael's Hospital from January 1, 1994, to December 31, 2003, inclusive. RESULTS: The data from this 10-year time span revealed a total of 124 patients with cervical spine injuries drawn from a cohort of 3356 patients with craniomaxillofacial fractures. The overall incidence of cervical spine injury was 3.69 percent. Of these patients, 928 had isolated upper third facial or skull fractures, whereas isolated middle third facial fractures were seen in 716 patients and isolated lower third facial fractures were present in 798 patients. Combined facial fracture patterns, involving two or more facial thirds, accounted for the greatest number of cervical spine injuries, occurring in 8.86 percent (n = 914). CONCLUSIONS: The relationship between cervical spinal injuries and craniomaxillofacial trauma has been better defined as it relates to a regional trauma registry. The implications as related to the trauma assessment, diagnosis, and treatment of these injuries are reviewed.