trauma to the orbit can result in considerable deformity of the face , but can also result in impairment of the vision . such kind of trauma may occur in various blunt injuries due to road traffic accidents ( rtas ) , assault , and sport activity . a true blowout fracture of the orbit involves only the floor of the orbit without involvement of orbital rim or any other associated facial bones . significant complications can occur as a result of these orbital injuries such as enophthalmos , persistent diplopia , vertical dystopia , and restriction of globe movements . the goal of surgical repair of orbital fractures is to restore the traumatized wall to prevent herniation of the contents of the globe into the maxillary sinus , as it causes undesirable fat atrophy , disturbance in the ocular motility , and related complication . various autogenous , alloplastic , and allogenic materials have been tried to reconstruct the orbital floor with varying rate of success . this study was conducted to use an alternative source of autogenous bone graft , with the specific aim to see the efficacy of anterolateral wall maxilla in orbital floor reconstruction . the aim of this paper is to present an alternative source of bone for use in grafting orbital floor defects . we are presenting management of orbital floor fracture compounded with zygomatico - maxillary complex fracture using anterolateral wall of maxilla as bone graft and mini plates for fixation of facial fracture . this study was carried out at datarkar institute of maxillofacial surgery , pratap nagar , nagpur . informed consent has been taken from all the patients after explaining the advantages and disadvantages of orbital floor reconstruction . total of five patients reported with history of rta having facial fractures associated with orbital wall disruption were included in the study . selected , three were male and two were female having varied presentation of facial asymmetry , diplopia , decreased extraoccular movements , and enopthalmous . patients were preoperatively examined clinically and evaluated by computed tomography ( ct ) scan to see the size of the defect [ figure 1 ] . preoperative computed tomography ( ct ) showing orbital floor fracture with herniation of contents subciliary incision was used to address orbital rim and floor of orbit . careful dissection was carried out and the defect in the floor was visualized . in all the patients the fractures were stabilized by miniplates . from the contralateral sides [ figure 2 ] , bone graft [ figure 3 ] of 1.5  2 cm size periorbital tissue herniating in the maxillary sinus was disengaged from bony defect and the harvested graft was adapted to the orbital floor [ figure 4 ] . all the patients were reviewed at regular interval , initially once every week for 1 month , followed by once in every month for next 6 months postoperatively . photograph showing donor site photograph showing harvested anterolateral wall of maxilla photograph showing graft placed at orbital floor five patients [ table 1 ] with orbital floor defects of medium size average 1.16 cm size ( range 0.8 - 1.5 cm ) were grafted by using autogenous bone graft harvested from anterolateral wall of maxilla . the average follow - up in this study was 6 months ( range 5 - 0 months ) . all the patients were successfully reconstructed with restoration of the orbital wall continuity . we have not come across any complications like infection , exposure , and extrusion of the graft . the postoperative ct scan showed good consolidation [ figure 5 ] of the graft maintaining the continuity of the orbital floor . only one patient did not show much improvement in enopthalmous where the size of the defect was large . the outcome of repair of orbital floor fracture depends upon proper diagnosis , timing of surgery , appropriate surgical approach , and selection of suitable graft . unrepaired orbital wall defects after facial fractures can result in enopthalmous and diplopia because of increased orbital volume , herniation of orbital contents , and atrophy of herniated fat and muscle . proper surgical timing is a paramount for producing good results , and most of the authors advocate early repair as late treatment would lead to fat atrophy and fibrosis of supporting ligaments . this may limit the surgeon 's ability to completely correct the enopthalmous as well as the position of the globe . the basic objective of reconstruction of orbital defect is to restore orbital volume , function , and esthetics . orbital floor reconstruction has been achieved using a wide variety of materials which includes cartilage and fascia homograft ( autogenous bone graft ( converse , et al . , 1961 ) , and alloplastic materials ( borghouts and otto , et al . , 1978 ) . autogenous graft is a well - established and relatively successful method of repairing orbital defects . very few cases of use of anterolateral wall of maxilla as a bone graft for reconstruction of orbital defects has been reported in the literature . the use of anterolateral wall of maxilla is an easy quicker method of harvesting bone graft . about 2  3 cm of the graft can be harvested which is sufficient for smaller to moderate size defects . harvesting of the graft is associated with minimal complication and most common amongst them is perforation in maxillary sinus , which subsequently heals uneventfully . bleeding from the nose is expected during initial 10 days of surgery which itself is collected blood in the antrum after harvesting bone graft . in the present study it was also observed that the contour of anterolateral wall of maxilla exactly fits the anatomic contour of orbital floor . several authors reported that membranous bone grafts maintain their volume to a greater extent compared with endochondral bone grafts . the reason for that could be bone grafts of membranous origin have higher cortical bone quality than those of endochondral origin . moreover , some other authors observed that cortical bone grafts will maintain their volume better than cancellous bone grafts , independent of embryogenic origin . zins and whitaker found that membranous bone grafts maintain their volume better than endochondral bone grafts when grafted on the rabbit snout . they hypothesized that this was because of the embryologic origin of the bone graft . using a similar animal model , they found that membranous bone grafts maintained their volume better than endochondral grafts , and they explained this phenomenon by earlier graft revascularization . in addition to differences in embryologic origin , endochondral and membranous bone grafts also differ in their micro architecture . membranous bone tends to have a thicker cortex and a denser , thinner cancellous layer than endochondral bone . several authors have theorized that a difference in micro architecture is the basis for the differential resorption of bone grafts . this technique provides a readily accessible , easily harvested source of bone for grafting orbital floor defects . patient acceptibility is very good and ease of intraoral surgery reduces the operating time , postoperative morbidity at donor site is minimal . the use of harvested bone graft from the anterolateral wall of the maxilla is better option for the reconstruction of orbital floor defects . the clinical and radiographic observations showed a very low rate of bone resorption and significant improvement in diplopia and correction of continuity of orbital floor defect . therefore , on the basis of this study , authors feel that the membranous origin of the bone from anterolateral wall of maxilla is a good source for reconstruction of moderate size orbital floor defects .
purpose : the aim of the present study was to assess the utility of anterolateral wall of maxilla as a bone graft to reconstruct the continuity of orbital floor.materials and methodsthis study was carried out at datarkar institute of maxillofacial surgery , pratap nagar , nagpur . out of five patients selected , three were male and two were female . 
 all the patients had intact anterolateral wall of maxilla on contralateral side . in all the patients 
 the reduction of the zygomatic complex fracture was done by keen 's approach . 
 the fractures were stabilized by miniplates . from the contralateral sides , bone graft of 1.5  2 cm size 
 was harvested from which were intact in all the patients . 
 all the patients were reviewed at regular interval , initially once every week for 1 month , followed by once in every month for next 6 months postoperatively.results:five patients with orbital floor defects of medium size average 1.16 cm size ( range 0.8 - 1.5 cm ) were grafted by using autogenous bone graft harvested from anterolateral wall of maxilla . 
 all the patients were successfully reconstructed with restoration of the orbital wall continuity . we have not come across any complications like infection , exposure , and extrusion of the graft . 
 only one patient did not show much improvement in enopthalmous where the size of the defect was large.conclusions:the use of harvested bone graft from the anterolateral wall of the maxilla is better option for the reconstruction of orbital floor defects .