Autologous Iliac Crest Bone Grafts in Orbital Floor Reconstruction: A Quantifying Study of Graft Resorption and Clinical Outcome

Abstract Background This study investigates bone graft resorption following orbital floor reconstruction with autologous iliac crest bone grafts. While autologous grafts are valued for their biocompatibility, concerns remain regarding unpredictable resorption and its potential impact on functional and aesthetic outcomes. Methods Between 2009 and 2013, 32 patients with pure blowout fractures were treated with iliac crest grafts. Of these, 10 consecutive patients (median age 47.5 years) met inclusion criteria. CT scans were analyzed at two points: immediately postoperative (T1) and at 12 months (T2). Graft volumes, orbital volume, and clinical outcomes, including enophthalmos and diplopia, were assessed. Results The mean initial graft volume of 903 mm³ decreased by 70% at T2. Despite significant resorption, orbital volume increased 3.2% due to bone remodeling. No clinically relevant enophthalmos or diplopia was observed. Donor site complications were minimal, with scarring being the most common. Conclusion Significant bone graft resorption does not impair long-term outcomes in orbital reconstruction. Remodeling enhances stability, supporting autologous iliac crest grafts as a cost-effective option, particularly in resource-limited settings. Further research is needed to explore the clinical implications of graft resorption.