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Different Intraorbital Implant Situations and Ocular Prosthetic Rehabilitation

Aggarwal H, Kumar P, Eachempati P, Alvi HA

J Prosthodont, 2016 Dec;25(8):687-693.
PMID: 26447725 DOI: 10.1111/jopr.12369

Enucleation is the removal of the entire globe of the eye and a portion of the optic nerve, while evisceration involves the removal of the contents of the globe leaving the sclera, extraocular muscles, and optic nerve. Following enucleation or evisceration, intraorbital implants are routinely placed to enhance the prosthetic outcome in addition to restoring the lost orbital volume. Current practice employs intraorbital implants made of nonporous silicone, hydroxyapatite, or porous polyethylene. Intraorbital implant selection and placement, being a highly demanding procedure in terms of knowledge, skill, and expertise, may be associated with a multiplicity of technical and surgical errors. Complications are usually minimal with these implants, but they do occur. The literature reveals many articles related to intraorbital implants, their benefits, and complications; however, the literature regarding the effect of various intraorbital implant situations on the subsequent prosthetic rehabilitation is markedly scarce. Moreover, the need for interdisciplinary surgical and prosthetic interventions required for successful rehabilitation in cases of compromised implant situations has been underemphasized. Hence, this review aimed to evaluate the effect of different intraorbital implant situations on ocular rehabilitation and the required interdisciplinary surgical and prosthetic treatment approach for rehabilitation of enucleated/eviscerated sockets with compromised implant situations, to provide a critical appraisal, and to present a simplified management strategy.

Matched MeSH terms: Orbital Implants*
Subperiosteal Dissection in Orbital Blowout Fracture: Technical Tips Including the Use of Modified Periosteal Elevator

Nazimi AJ, Rajaran JR, Nordin R

J Craniofac Surg, 2019 Oct;30(7):e609-e611.
PMID: 31503125 DOI: 10.1097/SCS.0000000000005617

Orbital blowout fractures are common. The same goes for its surgical complications when the efficiency of the dissection of entrapped or herniated intraorbital contents into the fracture could not be completely and safely dissected out. The authors describe a modification of the commonly used Howarth periosteal elevator for dissection of intraorbital content displacement or herniation on orbital blowout fracture. The instrument was modified by marking out the instrument from the tip into 10, 20, 25, 30, and 40 mm on both of its concave and convex surfaces to allow safe orbital soft tissue dissection and distance control. From the authors' experience, these simple modifications from its original instrument design allow better intraoperative control and appreciation of any intact important intraorbital anatomical structures such as inferomedial strut and posterior ledge. At the same time of importantly getting complete orbital fracture dissection and visualization, it causes less trauma to surrounding soft tissue with the markings ensuring unnecessary orbital exploration or visualization. Dissection can be kept for optimum maneuverability at the required or intended location based on the preoperative scan or dimension of anatomical orbital implant.

Matched MeSH terms: Orbital Implants
Fulltext Surface marker-assisted for orbital navigation surgery: a dry skull study

Nazimi, A.J., Nuraudi Zafirah, A.R., Nur Syaira, I., Izhar, A.A., Muhd Fazlynizam, R.

Medicine & Health, 2020;15(1):237-249.
MyJurnal

Tujuan kajian ini adalah untuk menerokai kaedah pembantu penanda permukaan terhadap implan orbital untuk pembedahan tulang orbit. Enam tengkorak manusia dewasa kering telah digunakan dalam kajian ini. Implan orbital aluminium yang disediakan secara individu, dengan ketebalan 0.4 mm disediakan untuk lantai orbit secara bilateral. Empat penanda permukaan implan fizikal dari aspek anterior dan posterior implan yang disediakan dan diimbas secara optik. Pemeriksaan pra-pembedahan tomografi berkomputer ‘cone-beam’ (CBCT) diperolehi untuk semua lantai orbit. Data 'Digital Imaging and Communications in Medicine' (DICOM) tengkorak diambil, diimport dan direka bentuk dengan format data stereolithografi (STL) implan orbital masing-masing menggunakan iPlan CMF (Versi 3.0, BrainLab, Jerman). Teknik gabungan imej dilakukan untuk setiap tengkorak selepas pembinaan semula dengan pengambilan pos-pembedahan CBCT. Pengukuran berasaskan daripada data tomografi terhadap posisi implant kemudian dinilai di antara kedudukan implan yang direncanakan dan yang direalisasikan dalam satah sagittal dan coronal. Analisa statistik dijalankan menggunakan Statistik Statistik PASW® 18. Hasil kajian menunjukkan bahawa 38 daripada 48 penanda permukaan yang dinilai menunjukkan peningkatan ketinggian kedudukan dalam skala kecil pasca-pembedahan berbanding dengan kedudukan implan orbital maya. Semakan metrik Euclidean menunjukkan perbezaan yang kurang daripada 1.00 mm dalam semua penanda permukaan kecuali pada kawasan lej posterior dan anterior dalam penilaian satah sagittal. Kajian ini menunjukkan bahawa penempatan penanda permukaan terhadap implant orbit dalam pembedahan navigasi orbit menyumbang kepada kedudukan implan orbital secara konsisten.

Matched MeSH terms: Orbital Implants
Combination of skin flap and silicone prosthesis for rehabilitation of a large orbital defect: A case report

Jamayet NB, Rahman AM, Nizami MMUI, Johari Y, Husein A

Indian J Dent Res, 2018 12 28;29(6):840-843.
PMID: 30589017 DOI: 10.4103/ijdr.IJDR_20_17

Exenteration surgery greatly affects a person in terms of function, esthetics, and psychological trauma. In such cases, restoration by silicone orbital prosthesis is a well-accepted treatment option. However, this is a difficult task, necessitating personalized design of method for each patient. This case report describes the technique for fabrication of a silicone orbital prosthesis for a male patient with left orbital defect due to exenteration of a Grade 3 squamous cell carcinoma of the left eye and surrounding tissues. The patient was delivered with a satisfactory silicone orbital prosthesis having good retention and finish. Multidisciplinary management and team approach are crucial in providing precise and effective rehabilitation for improving the patient's quality of life and help them return to their normal social life.

Matched MeSH terms: Orbital Implants
Comparison of Clinical Results and Pathological Examinations Between Locally Synthesized Bone-derived Hydroxyapatite and Medpor® Orbital Implants in Animal Models

Roslinah M, Wan Hitam WH, Md Salleh MS, Abdul Hamid SS, Shatriah I

Cureus, 2019 Jan 25;11(1):e3954.
PMID: 30956907 DOI: 10.7759/cureus.3954

We aimed to compare clinical and pathological reactions towards locally synthesized bovine bone derived from hydroxyapatite (bone docosahexaenoic acid (dHA)) and commercially available porous polyethylene (Medpor®, Porex Surgical Incorporation, Georgia, USA) orbital implants in animal models. An experimental study was performed on 14 New Zealand white rabbits. Group A (n=7) was implanted with bovine bone dHA and group B (n=7) was implanted with Medpor®. Clinical examinations were performed on Days 1, 7, 14, 28, and 42 post-implantation. The implanted eyes were enucleated on Day 42 and were sent for pathological evaluation. Serial clinical examinations included urine color and odor; feeding and physical activity demonstrated normal wellbeing in all the subjects. Localized minimal infection was observed in both groups during the first two weeks following implantation, and the subjects responded well to topical moxifloxacin. Both groups exhibited evidence of wound breakdown. No signs of implant migration or extrusion were observed in either group. The histopathological examination revealed no statistically significant difference in inflammatory cell reactions and fibrovascular tissue maturation between both types of implants. However, all (100%) of the bovine bone dHA implants displayed complete fibrovascular ingrowth compared to Medpor® implants (57.1%) at six weeks post-implantation (p=0.001). In conclusion, bovine bone dHA and Medpor® orbital implants were well-tolerated clinically and displayed similar inflammatory reactions and fibrovascular tissue maturation. Locally synthesized bovine bone dHA orbital implants displayed significantly greater complete fibrovascular ingrowth in comparison with Medpor® implants.

Matched MeSH terms: Orbital Implants
Biomaterials for repair of orbital floor blowout fractures: a systematic review

Gunarajah DR, Samman N

J Oral Maxillofac Surg, 2013 Mar;71(3):550-70.
PMID: 23422151 DOI: 10.1016/j.joms.2012.10.029

To evaluate the reported use and outcomes of implant materials used for the restoration of post-traumatic orbital floor defects in adults.

Matched MeSH terms: Orbital Implants*
Intraoperative Computed Tomography Scan for Orbital Fracture Reconstruction

Nazimi AJ, Khoo SC, Nabil S, Nordin R, Lan TH, Rajandram RK, et al.

J Craniofac Surg, 2019 Oct;30(7):2159-2162.
PMID: 31232997 DOI: 10.1097/SCS.0000000000005667

Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory reconstruction by correct positioning of orbital implant. Intraoperative computed tomography (CT) scan may facilitate this procedure. The aim of this study was to describe the early use of intraoperative CT in orbital fractures repair in our center. The authors assessed the revision types and rates that have occurred with this technique. With the use of pre-surgical planning, optical intraoperative navigation, and intraoperative CT, the impact of intraoperative CT on the management of 5 cases involving a total number of 14 orbital wall fractures were described. There were 6 pure orbital blowout wall fractures reconstructed, involving both medial and inferior wall of the orbit fracturing the transition zone and 8 impure orbital wall fractures in orbitozygomaticomaxillary complex fracture. 4 patients underwent primary and 1 had delayed orbital reconstruction. Intraoperative CT resulted in intraoperative orbital implant revision, following final navigation planning position, in 40% (2/5) of patients or 14% (2/14) of the fractures. In revised cases, both implant repositioning was conducted at posterior ledge of orbit. Intraoperative CT confirmed true to original reconstruction of medial wall, inferior wall and transition zone of the orbit. Two selected cases were illustrated. In conclusion, intraoperative CT allows real-time assessment of fracture reduction and immediate orbital implant revision, especially at posterior ledge. As a result, no postoperative imaging was indicated in any of the patients. Long-term follow-ups for orbital fracture patients managed with intraoperative CT is suggested.

Matched MeSH terms: Orbital Implants
Fulltext Delayed onset porous polyethylene implant-related inflammation after orbital blowout fracture repair: four case reports

Aryasit O, Ng DS, Goh ASC, Woo KI, Kim YD

BMC Ophthalmol, 2016 Jul 07;16:94.
PMID: 27387333 DOI: 10.1186/s12886-016-0287-0

BACKGROUND: Porous polyethylene implants are commonly used in orbital blowout fracture repair because of purported biocompatibility, durability, and low frequency of complications. Delayed inflammation related to porous polyethylene sheet implants is very rare and no case series of this condition have been reported.
CASE PRESENTATION: This is a retrospective review of clinical presentations, radiographic findings, histopathological findings, treatments, and outcomes of patients who developed delayed complications in orbital blowout fracture repair using porous polyethylene sheets. Four male patients were included with a mean age of 49 years (range 35-69 years). Blowout fracture repair was complicated with implant-related inflammation 10 months, 2 years, 3 years, and 8 years after surgery. Chronic and subacute orbital inflammatory signs were noted in two patients and acute fulminant orbital inflammation was found in two patients. Three patients developed peri-implant abscesses and one patient had a soft tissue mass around the implant. All patients underwent implant removal and two of these patients with paranasal sinusitis had sinus surgery. Histopathological findings revealed chronic inflammatory changes with fibrosis, and one patient had foreign body granuloma with culture positive Staphylococcus aureus.
CONCLUSIONS: Delayed complications with porous polyethylene sheets used in orbital blowout fracture repair may occur many years following the initial surgery in immunocompetent patients. Low-grade or fulminant inflammation could complicate blowout fracture repair related with the implant.

Matched MeSH terms: Orbital Implants/adverse effects*