Post exenteration surgery rehabilitation with orbital prosthesis – A case report

Orbital defects with total loss of eyelids and the eyeball cannot be satisfactorily repaired by reconstructive surgery. Therefore, a prosthetic placement is the treatment of choice to return the individual’s confidence by producing an acceptable and lifelike appearance. Male patient, 31 years old, came with history of exenteration surgery four months ago on right eye because of infection few years before. Patient wanted orbital prosthesis to improve esthetic and self-confidence. He lost his right eye ball and some part of right eyelid. Treatment of choice that would be fabricated was orbital prosthesis with medical adhesive retention support. Orbital prosthesis was one of the alternative that can be chose to reconstruct orbital defect. The success of the prosthesis was determined by the exactness of diagnosis, treatment plan determination, material selection, determination of prosthesis retention, and technique in processing the prosthesis.

Analysis of the Results of Reconstructive and Restorative Operations in Post-Traumatic Orbital Defects by Computer Simulation

Treatment of patients with post-traumatic orbital defects is relevant problem of ophthalmology and maxillofacial surgery. Residual diplopia or dislocation of the eyeball leads to disability, social maladaptation and development of psychoemotional disorders in patients. In this paper, we present an evaluation of treatment of patients with posttraumatic orbital wall defects based on the retrospective comparative analysis of CT data by computer simulation before and after reconstruction. When comparing the volume of the injured orbits before and after the operation (average volume difference was 2.7 ± 0.9 cm3), a significant improvement was found in terms of recovery of the orbital volume. The factors influencing the treatment effectiveness were determined based on the calculation of the volume of the orbits on the healthy and injured side in the software environment before and after the reconstruction. The causes of the detected cases of incomplete recovery of the orbital volume were analyzed. The solution to the problem of restoring the orbital volume is in the plane of restoring the geometry of the orbit because previous adaptation of the shape of the standard plate to its anatomical structure with overlapping defect on the stereolithographic model provided the best end result. Conclusions. Personalized adaptation of the implants to the shape of the orbit or individual production thereof can increase the accuracy of the orbital volume restoration, which can increase the effectiveness of eliminating complications such as enophthalmos and diplopia. The effectiveness of treatment of post-traumatic orbital defects by traditional methods directly depends on the severity of the damage, the degree of which determines the magnitude of the change in the orbital volume. However, the greater is the volume of the orbit changes as a result of the injury, the worse is the prognosis for its recovery. Development of the ways to individualize implants and evaluate their effectiveness is an important area for further research. Keywords: post-traumatic orbital defects, reconstructive surgery, computer simulation.

Oscillopsia following orbitotomy for intracranial tumor resection

Background: Oscillopsia is a visual phenomenon in which an individual perceives that their environment is moving when it is in fact stationary. In this report, we describe two patients with pulsatile oscillopsia following orbitocranial approaches for skull base meningioma resection. Case Description: Two patients, both 42-year-old women, underwent orbitocranial approaches for resection of a right sphenoid wing (Patient 1) and left cavernous sinus (Patient 2) meningioma. Patient 1 underwent uncomplicated resection and was discharged home without neurologic or visual complaints; she presented 8 days later with pulsatile oscillopsia. This was managed expectantly, and MRA revealed no evidence of vascular pathology. She has not required intervention as of most recent follow-up. Patient 2 developed trochlear and trigeminal nerve palsies following resection and developed pulsatile oscillopsia 4 months postoperatively. After patching and corrective lens application, the patient’s symptoms had improved by 26 months postoperatively. Conclusion: Oscillopsia is a potential complication following skull base tumor resection about which patients should be aware. Patients may improve with conservative management alone, although the literature describes repair of orbital defects for ocular pulsations in traumatic and with some developmental conditions.

Maxillofacial Prosthesis for Combined Intra and Extra-Oral Defect – A Case Report

Combined intra and extra oral defects can be stated as those facial defects which have an intraoral communicating route. Midfacial defects are aptly classified into 2 major categories by Marunick et al. 1 as midline midfacial defects in which the nose and / or upper lip defects are included; and the second major group was lateral defects in which the cheek and orbital defects are categorized. However, defects which include combinations of the above-mentioned defects are in existence. Midfacial defects which are acquired, present themselves often with severe disfigurement of structures and hence show impaired function. It is a meticulous task to rehabilitate the defects which are caused as a result of cancerous lesion resection as they are huge. Such post resection lesions frequently are rehabilitated by a facial prosthesis to maintain function as well as the appearance in the normal form. In adjunction to the facial prosthesis, an intraoral prosthesis which constitutes of an obturator is also required to regain the natural speech and pattern of swallowing. Fabrication of such facial prosthesis not only requires the artistic capability but also excellent clinical decision making of the prosthodontist. Mode of retention of the combined prosthesis should also be kept in mind while fabricating as it is also a difficult task to retain them because of the size and weight of the same. Moreover the prosthesis should also be secured in its place with these aids which can also prove as a challenge. This case report states rehabilitating a large surgically resected midfacial defect with the assistance of a “3-piece prosthesis” which constitutes a sectional intraoral obturator along with maxillary and mandibular extraoral facial prosthesis.

Reconstruction of Orbital Exenteration Defects with Cheek Rotation Flaps: Indications, Technique, Complications, Rehabilitation, and Survival

The objective of this study was to examine the role of cheek rotation flaps in the reconstruction of orbital defects after exenteration. From January 2000 to August 2018, patients undergoing orbital exenteration and reconstruction with cheek rotation flaps were enrolled in this retrospective study. All patients were evaluated for wound complications, orbital rehabilitation, tumor relapse, and survival. Thirty patients completed the study. Fourteen complications allocated to 11 patients were assessed. The most common complications were seroma (13%), temporary facial nerve weakness (13%), and partial necrosis of the flap (10%). A major complication occurred in a total of two patients (7%), so that surgical correction was necessary. Eleven patients had a relapse; 15 patients died as part of the follow-up. Fifteen patients were treated with facial prostheses. The overall survival rate was 61% after 1 year and 42% after 5 years. Follow-up periods ranged from 6 to 95 months. Cheek rotation flap reconstruction after exenteration is a reliable method with a low rate of major complications. It is indicated when an approach to the parotid gland or the neck region is necessary because of suspected lymph node metastasis and in elderly patients because of their skin's laxity. It can be performed as primary or secondary reconstruction. Good esthetic results can be achieved, especially after endosseous implantation.

Efficacy of application of a patient-specific implants in treatment of the orbit walls defects, combined with a cheekbone complex fractures

Objective. To study a clinical efficacy of application of a patient-specific implants for elimination of posttraumatic orbital defects, combined with a cheekbone complex fractures, comparing with standard methods of reconstruction. Materials and metods. Retrospective analysis of the treatment results was conducted in 43 patients of the main group (n = 25) and in a control one (n = 18), who suffered posttraumatic orbital defects, combined with a cheekbone complex fractures, including the rate of postoperative enophthalm, diplopia and difference of volume between reconstructed and intact orbit. Results. Average square of the defects in the patients examined have constituted (6.3 ± 3.5) cm2. The postoperative enophthalm rate in the main group have constituted 18%, in a control one - 44.4%, diplopia rate - accordingly, 16 and 44.4%. Average difference between volume of the intact and traumatized orbit in the main group have constituted (0.94 ± 0.65) cm3 and in a control one - (2.4 ± 2.3) cm3. Conclusion. Significant square of the orbit walls damage with extension towards apical parts is characteristic for posttraumatic orbital defects, combined with a cheekbone complex fractures. Reconstruction of orbit and a cheekbone complex, using a patient-specific implants, permits to guarantee an effective rehabilitation of the patients concerning elimination of posttraumatic enophthalm with low risk for the vision acuteness lowering.

Reconstruction of the Orbit

Orbital defects require careful consideration due to the need to protect globe position and visual function. The orbit’s unique geometry requires working within a confined space. When indicated, orbital rim fractures or segmental defects can be reconstructed using low-profile, titanium mini-plates. Multiple implant options are available to support the globe when defects involve the orbital floor or medial wall. These materials should be able to contour to match the concavity of the orbit, thereby avoiding changes in orbital volume. For complex defects, virtual surgical planning strategies, including intra-operative navigation or the use of anatomic models for pre-operative plate bending or cutting guides for secondary osteotomies, can improve precision and reduce operative time. This chapter will describe operative indications and practical management options for orbital defects. This review contains 7 figures, 1 video, 2 tables, and 38 references. Keywords: orbit anatomy, periorbital trauma, orbital reconstruction, craniofacial imaging, alloplastic implant, mini plate, surgical approach, virtual surgical planning

Intraoperative Navigation and Cone Beam Computed Tomography for Restoring Orbital Dimensions: A Single-Center Experience

Background: Correction of post-traumatic orbital defects remains a challenge for the maxillofacial surgeon. We examined the added value of combined intraoperative (IO) navigation and IO cone beam computed tomography (CBCT). Materials and Methods: A retrospective cohort study was performed in all consecutive patients requiring unilateral post-traumatic orbital surgery between January 2012 and December 2018. Patients were divided into 3 groups: IO navigation (NAV), IO-CBCT (CBCT), and IO navigation with IO-CBCT (NAV-CBCT). A detailed description of our workflow is provided. Volumetric comparison of the operated orbit to the contralateral orbit was made with Brainlab. Results: Of the 81 cases, 22 patients were included (12 males/10 females) with a mean age of 51 years. Three patients were assigned to NAV, 6 to CBCT, and 13 to NAV-CBCT. The reconstructed orbital volume did not significantly differ from the contralateral orbital volume within the 3 groups. The mean difference between the contralateral and the operated orbit was 3.05 cm3, 3.72 cm3, and 1.47 cm3 for NAV, CBCT, and NAV-CBCT, respectively, where only NAV-CBCT showed a significant smaller volumetric difference in comparison to CBCT alone. Gender or age did not correlate with difference in orbital volume. Normal function and aesthetics was seen at 6 weeks postoperative in 0 of 3, 6of 6, and 6 of 13 patients of the NAV, CBCT, and NAV-CBCT, respectively. Conclusion: Orbital defects can be treated effectively using IO navigation. Although our data could not demonstrate a significant added value of IO-CBCT in cases where IO navigation was used based on volumetric difference alone, the combination of IO-CBCT and IO navigation seems to give the best results considering both volumetric difference and postoperative function and aesthetics. Confirmation in a prospective, randomized trial with a larger sample size is required.