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.

Implant-supported orbital prosthesis: a technical innovation of silicone fabrication

Background Silicone-based facial prostheses have traditionally been considered difficult to make and require time-consuming fabrication due to their basic liquid characteristics. Methods and results A detailed procedure for creating an ideal silicone orbital prosthesis was developed, including dental implant-supported retention, three-dimensional (3D) orbital scanning with symmetric volume and size measurement based on matching the opposite side, master mold fabrication for convenient pouring of the liquid silicone elastomer, and easy and comfortable management of the prosthesis by the patient. Conclusion A silicone orbital prosthesis could be more easily and conveniently produced using updated surgical skills and modern 3D technology. The combination of 3D scanning with digital reconstruction and an innovative fabrication protocol using a reproducible major mold and multiple prototypes fitting resulted in an accuracy personalized facial prosthesis with accessible cost and short production period.

The influence of the locomotor stump’s form on the ocular prosthetics result with different methods of eye removal

Aim. To determine the optimal shape of the locomotor stump and the configuration of the corresponding ocular prosthesis, ensuring their maximum motility in patients with anophthalmia with different methods of eye removal. Materials and methods. The study group consisted of 132 patients aged 1880 years after enucleation or evisceration. Examination methods included medical history; examination of eyelids, measurement of length and width of the palpebral fissure, as well as of the depth of conjunctival fornices on both sides; assessment of the volume, shape, surface topography, position and excursions of the locomotor stump, of the protrusion of the ocular prosthesis compared to the contralateral eye; photo registration of the studied parameters. Results. During the study, there were 3 types of locomotor stump identified: moderate with retraction in the upper third; voluminous flattened; voluminous hemispherical. The locomotor stump after enucleation was voluminous flattened or moderate with retraction in the upper third. The best motility of the locomotor stump was noted nasally and downward. The motility of the ocular prosthesis was 47.4% compared to the contralateral eye. The locomotor stump after evisceration with keratectomy was voluminous hemispherical or voluminous flattened. Its motility in all four directions was about the same. The motility of the ocular prosthesis in comparison to the contralateral eye was 55.9%. The locomotor stump after evisceration without keratectomy was voluminous hemispherical, uniform, smooth. The motility of the locomotor stump was maximal in comparison to other groups and relatively equal in all four directions. The motility of the ocular prosthesis in comparison to the contralateral eye was 68.2%. Conclusion. The optimal shape of the locomotor stump, providing the greatest motility of the ocular prosthesis is voluminous hemispherical. The same protrusion of the eyeball and that of the cosmetic prosthesis relatively to the frontal plane after enucleation is achieved by increasing the thickness of the prosthesis itself, which reduces its motility. Evisceration with implantation of the orbital prosthesis involves the use of a thin-walled ocular prosthesis, the back surface of which ideally repeats the locomotor stump surface and does not prevent its maximum motility. When removing a squinting eyeball with preserved corneal diameter, a smaller implant should be used to prevent excessive opening of the palpebral fissure, or to prefer evisceration with keratectomy.