Isolated orbital fractures constitute 4% to 6% of facial fractures and the incidence reaches up to 30% to 55% when combined with other facial bone fractures (1).
Blow–out fractures are caused by direct trauma to the globe which causes an increase in intraorbital pressure and decompression via fracture of the orbital floor (2).
Orbital trauma is largely the result of motor vehicle accidents, industrial accidents, sports-related facial trauma, and assaults. Motor vehicle accidents, particularly those in which seatbelts are not worn, are usually the most common cause of maxillofacial trauma, as shown in large series in developed nations.In the adult female population, nonaccidental injury in the form of domestic violence should be specifically assessed during history-taking, because this is a common cause of orbital fractures in this group (3).
The patient commonly complaining of ecchymosis , black eyes ,limitation of eye movements, diplopia, enophthalmos and very rarely severe pain and nausea immediately after the injury (4). Computed tomography, plane radiology and magnetic resonance imaging may be used in the evaluation of the orbital trauma (5).
Timing of and method used for reconstruction of orbital floor is controversial. Surgical repair is indicated in diplopia, severe enophthalmos (>2mm), and large fractures (50% or more of floor) (6).
The goal of reconstruction in the orbital blow-out fractures are to restore floor continuity, provide support of orbital contents and prevent fibrosis of soft tissues (7).
Reconstruction of orbital blow-out fractures can be carried out with alloplastic or autogenous graft. Autogenous grafts include bones (calvarium, rib and iliac crest) and cartilages (nasoseptal, conchal and rib). Autogenous bone is an ideal material for grafting (8).
Alloplastic materials include porous polyethelene (medpore surgical implant), high density polyethelene (marlex), and silicone (silastic).The popularity of these synthetic materials is largely owing to their availability and convenience with long-term satisfactory results. However, some complications including extrusion, infection and dacryocystitis have been reported (9).
Autogenous grafts provide better biocompatibility. However they cause donor site morbidity, additional operative time and potential problems of graft resorption (10).