COMPLICATIONS OF ORBITAL RECONSTRUCTION - MISPLACEMENT OF BONE-GRAFTSWITHIN THE INTRAMUSCULAR CONE

Surgical reconstruction of the orbit has a complication rate of 10 to 15 percent. Ectropion and scleral show are common postsurgical sequela e that may be minimized by using accurate dissection planes, close att ention to hemostasis, and resuspension of the soft tissue. Inadequate restoration of orbital volume manifested as enophthalmos or dystopia i s also common, and may be minimized if precise anatomical reconstructi on of orbital volume is achieved. Less common complications include di plopia and rarely blindness, which may have several causes such as ret robulbar hemorrhage, aggressive mobilization of zygomatic fractures wi th extension of fracture lines to orbital apex, blind packing of the m axillary antrum, the use of large orbital implants, and retinal detach ment. The use of autologous bone grafts for orbital reconstruction is well accepted. Significant donor site morbidity from harvesting bone g rafts occurs (5 to 9 percent) and is donor site related, manifested as minor dural tears, pneumothorax, hematoma, or nerve injury. Bone graf ting is usually uneventful, and the concept has greatly improved the t reatment of orbital fractures. Migration of bone grafts and interferen ce with extraocular motion are two complications of bone graft placeme nt. Intraconal placement of bone grafts during orbital reconstruction has not been reported in the literature. We are reporting three cases of intraconal bone graft placement and two cases of muscle impingement by bone grafts as complications of orbital reconstruction.