Rehabilitation of orbital defect with silicone orbital prosthesis retained by dental implants

Osseointegrated Implants for Orbito-Facial Prostheses: Common Complications and Solutions

PURPOSE

To evaluate anatomical and functional results of osseointegration with magnetic coupling for oculofacial prosthetic rehabilitation after exenteration.

METHODS

This retrospective study included 11 consecutive patients who received orbital reconstruction and oculofacial prosthetic rehabilitation between September 2015 and October 2019. Patient demographics, surgical indications, previous treatment procedures, histopathologic features, and reconstructive procedures were recorded.

RESULTS

The mean age was 37.81 ± 23 years (range 5-78 years). The mean follow-up was 23.81 ± 12 months (range 10-48 months). The principal diagnoses were squamous cell carcinoma of the eyelids (n = 2/11), mucoepidermoid carcinoma of the maxillary sinus (n = 2/11), rhabdomyosarcoma (n = 1/11), mucormycosis (n = 1/11), neurofibromatosis (n = 1/11), basosquamous carcinoma (n = 1/11), malign melanoma (n = 1/11), primitive neuroectodermal tumor (n = 1/11), and retinoblastoma (n = 1/11). Six of the patients were repaired by primary closure. Procedures performed to reconstruct the orbital cavity included split-thickness skin graft (n = 2/11), temporalis muscle flap (n = 2/11), and frontalis muscle flap (n = 1/11). Nine of the 11 patients who received orbital implants were successfully rehabilitated by epithesis. Postoperative complications included implant loss (n = 4/11), periprosthetic local infection (n = 3/11), and soft tissue overgrowth around the orbital prosthesis (n = 2/11). All patients had Straumann bone level implant (Basel, Switzerland) osseointegrated titanium implants (3.5 mm) placed in a 2-stage procedure over a span of 3 to 4 months with subsequent successful prosthesis fitting.

CONCLUSION

The reconstructive methods following orbital exenteration, should be customized according to the patients' characteristics such as extension of the orbital defect, bone quality, and expectations to achieve satisfactory results.

Reproducible Major Mold for a Silicone Orbital Prosthesis Prototype

ABSTRACT

The implant-supported magnet-retained silicon orbital prosthesis (SOP) was reported as a reliable method to restore the health-related quality of life of patients who underwent facial resection and reconstruction surgery. Currently, fabrication usually requires a long production time and a high level of expertise. Moreover, due to the complex features of facial defects, accurate prosthesis requires many patient fittings.The prosthesis was designed to repair a complex orbital defect. A reproducible major mold was used to make various silicone prototypes with differences in margin design, silicone shade, and artificial eye's details. The most suitable silicone prototype was chosen for the finalization of the SOP. The patient reported the satisfaction with the function, prosthesis retention, and esthetic restoration.This clinical study showed that the new technique using a reproducible major mold can allow the fabrication of various prototypes, save time during fitting, and help in improving personalized fabrication of the SOP.

Orbital implants: State-of-the-art review with emphasis on biomaterials and recent advances

In the treatment of severe oculo-orbital traumas, intraocular malignancies or other life-threatening conditions it is sometimes necessary to surgically remove the patient's diseased eye. Following the removal of the eye, an orbital implant is inserted into the anophthalmic socket in order to provide satisfactory volume replacement and restore the aesthetic appearance of a normal eye. Over the last decades, the implant design and the criteria of materials selection evolved from simple non-porous polymeric sphere to devices with more complex shape and functionalities for ensuring better clinical outcomes in the long-term. Polymeric and ceramic porous implants have gained prominence since their highly interconnected porous architecture allows them to act as a passive framework for fibrovascular in-growth offering reduced complication rates and the possibility of pegging to enhance the motility of the artificial eye. However, there are still drawbacks to these materials. Some critical aspects of today's orbital implants include the risk of migration and extrusion, postoperative infections and low motility transmitted to the aesthetic ocular prosthesis. Hence, the development of novel biomaterials with enhanced functionalities (e.g. angiogenesis, antibacterial effect, in situ mouldability) which enable an improved outcome of eye replacement is more than ever desirable and represents one of the most challenging topics of research in the field of ocular implants. This review summarizes the evolution of orbital implants and provides an overview of the most recent advances in the field as well as some critical remarks for materials design, selection, characterization and translation to clinical applications.