Orbital roof fractures: Considerations for reconstruction

Purpose This paper aims to update current knowledge on orbital roof fractures and their reconstruction techniques through a multicenter experience, a literature review and detailing two cases involving autologous and heterologous bone grafts. Methods A Medline search from 2018 to 2023 was conducted, alongside a retrospective review of similar cases treated across four Italian hospitals. Inclusion criteria required all clinical and radiological data to be available, with a minimal follow-up of 6 months. Results Coronal incision was most common in the 16 studies analyzed, with titanium mesh or plates as primary reconstruction materials. Only four cases utilized autogenous bone, and dislocated bone fragment removal occurred in four patients. Early treatment was prioritized for emergencies, with 70 % of cases undergoing coronal incision. Most cases required defect reconstruction, primarily with titanium mesh. One patient experienced late rhinoliquorrhea, and only one required revision surgery. Conclusion Conservative approaches were mostly favored, with early intervention reserved for enophthalmos and ocular movement impairment. Upper eyelid blepharoplasty approach was considered safe for cases without intracranial injuries or frontal bone fractures. Heterologous bone grafts emerged as a potential alternative to titanium mesh, while autogenous bone harvested from the frontal box reduced operative time and complications in delayed treatments. VSP custom-made prosthesis can be utilized in complex fractures.