A Prospective Study to Compare the Functional and Aesthetic Outcomes with and without Primary Bone Grafting in Facial Fractures
Dr. Narayanamurthy Sundaramurthy,
3, 6th Floor, Block 3, Pace Prana Apartments, 109, Padikuppam Road Anna Nagar West Extension,
Chennai-600 040, Tamil Nadu, India.
Introduction: Open Reduction and Internal Fixation (ORIF) has been the gold standard in treatment of facial fractures. Bone grafts have been used to correct bone defects in face. Many studies assessing outcomes of ORIF and primary bone grafting separately have been published in literature.
Aim: A prospective study to compare the functional and aesthetic outcomes with and without primary bone grafting in facial fractures.
Materials and Methods: Thirty patients, admitted between January 2012 and December 2013, were divided into two groups. Group 1 patients underwent ORIF with primary bone grafting and in group 2, only ORIF was done. Clinical and functional, photographic and radiological assessments were done after one month and three months.
Results: Mean value of vertical dystopia in groups 1 and 2 after three months postoperatively were 1.25mm and 0.67mm. Mean value of enophthalmos in groups 1 and 2 after three months postoperatively were 0.5mm and 1mm. Thus, vertical dystopia was corrected better without bone grafts and enophthalmos corrected better with bone grafts. Photographic assessment revealed no statistical difference between the two groups. Postoperatively, in upper face fractures, both groups had similar number of patients in grades 1 and 2. Only one patient from group 2 of midface fractures ended up with grade 3 asymmetry. Radiologically, in upper face fractures, group 2 had more mean projection, height and breadth deficits (1.28mm, 2.57mm and 2.42mm) when compared to group 1 (0.67mm, 1.50mm and 0.50mm). The mean projection and height deficits were statistically better in group 1. In midface fractures, mean zygomatic complex projection and height deficits were more in group 2 (1.88mm and 0.63mm) than group 1 (0.78mm and 0.44mm). The mean zygomatic complex projection was statistically better in group1. Postoperative complications were lesser with the bone graft group.
Conclusion: Judicious use of bone grafts in comminuted facial and orbital floor fractures primarily can give better functional and aesthetic outcomes.