Retroseptal structural fat grafting to correct paediatric post- traumatic enophthalmos

Introduction Orbital volume deficiency is caused by various diseases and it can be present in different clinical scenarios. Orbital volume replacement in the posttraumatic enophtalmos is currently addressed by different surgical methods. Several autologous tissues and alloplastic materials have been used. The purpose of this article is to introduce our experience in the management of 8 complex cases of post traumatic enophthalmos treated successfully by retroseptal autologous fat grafting. Case series To address the research purpose, we designed a retrospective case series. Our study was based on 8 patients (mean age 10.5 years: range, 5-16 years; 6 males and 2 females) who underwent fat grafting for postoperative orbital defect. All patients had monolateral amaurosis and post-traumatic enophthalmos. Postoperative follow-up was recorded at 1 week and at 1, 3, and 6 months and 12 months with an accurate physical examination and clinical photography. We evaluated the outcome of these surgical procedures by measuring the morphological change of the face with a software package (Adobe Photoshop, Microsoft Corporation, CA). The preoperative photograph of the healthy side of the face has been reflected with the software to obtain the virtual ideal face (VIF). Postoperatively, we compared the VIF with the postoperative photograph. We obtained a similar facial morphology in 6 patients. Discussion Fat grafting in the intraconal space has been described in the treatment of enophthalmic orbit using a sharp needle. Hunter investigated the effects of intraconal fat grafting in patients with post-traumatic enophthalmos; it was used either in patients with a healthy eyeball or in those with anophthalmic sockets and he stated that enophthalmos is stabilized within the first 3 months with this technique. He obtained overall good results, but in 64% of cases, multiple injections were necessary. Malet described a consistent number of patients with anophthalmic sockets treated by injection into the deep upper eyelid sulci. Hardy described a retrospective study on 12 patients with anophthalmic and enophthalmic orbital cavity. Conclusion Fat grafting can be safely carried out in the treatment of the enophthalmic orbit. It has a long-lasting effect and can be a valid alternative to other autologous tissues or alloplastic materials.