Orbital Floor Reconstruction: Three-Dimensional Analysis Demonstrates Comparable Morphology of Scapular and Iliac Crest Bone Grafts

Publication date: Available online 28 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Joel C. Davies, Harley HL. Chan, Jonathan M. Bernstein, David P. Goldstein, Jonathan C. Irish, Ralph W. Gilbert
PurposeCurrent non-vascular osseous reconstructive options for reconstruction of the orbital floor following maxillectomy include options such as the scapular tip and iliac crest bone grafts. The aim of this study was to determine whether these donor sites were morphologically comparable to the orbital floor.MethodsA retrospective cross-sectional study design was selected. Using a pre-existing melanoma database (January 1, 2005-September 20, 2015), CT scans of the head, neck, thorax and pelvis were obtained from patients without evidence of bony metastases. Using 3D software (Mimics, Materialise, Leuven, Belgium), grafts from the scapulae and iliac crests, the predictor variables, were digitally harvested, co-registered with the orbital floors bilaterally and analyzed. The primary outcome was conformance. Data were analyzed using descriptive statistics and tests of statistical significance. The significance level was set at a P value less than or equal to .05.ResultsThe study sample included 10 patients (6 males, 4 females; mean age 55±18). A close conformance was observed when analyzing the morphology of the orbital floor to the scapular (2.23±0.31mm) and iliac crest (2.13±0.30mm) bone grafts with no significant difference between sites. Conformance mapping demonstrated maximal conformance centrally (scapula:1x10-3±1x10-3mm;iliac crest: 1x10-3±1x10-3mm) with decreased morphologic similarity peripherally (scapula:6.09±0.94mm;iliac crest: 5.74±0.88mm). There was no significant difference in conformance between sides of graft harvest.ConclusionWhen considering non-vascularized bone grafts for reconstruction of the orbital floor, both the scapula and iliac crest offer near complete conformance to the orbital floor structure and represent reasonable reconstructive options.



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