Eye socket reconstruction in patients with severe depressed eye socket combined anophthalmos
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Abstract:
Objective
To summarize the effect of eye socket reconstruction in patients with severe depressed eye socket combined anophthalmos and to assess the methods of eye socket reconstruction.
Methods
Forty patients of severe depressed eye socket combined anophthalmos, from Oct, 2001 to Mar, 2014, underwent eye socket reconstruction in Beijing Tongren Hospital. Thirty four eye sockets were reconstructed with free flap, the scapular flap in 2 cases, the forearm flap in 17 cases, the lateral arm flap in 15 cases. The reversed submental island flap was utilized in 2 patients. The other 4 cases were treated by implant-retained orbital prosthesis.
Results
All the patients were followed up for more than 2 years. The flaps survived. The artificial eye could be fitted satisfactorily and the appearance of the ill eye socket was improved significantly. The implant-bodies in orbital bone and the prosthesis were stable without peri-implantitis.
Conclusions
The flap transfer is effective for eye socket reconstruction in patient with severe depressed eye socket combined anophthalmos. The implant-retained orbital prosthesis is also alternative. The treatment choice must be based on the patient＇s own conditions.
Key words:
Depressed eye socket; Anophthalmos; Flap; Eye socket reconstructionKeywords:
Ocular prosthesis
Severe orbital soft-tissue loss and contracted eye sockets often present in patients who have had enucleation, exenteration, or other ocular diseases. In this article, the authors report a novel contracted eye socket reconstruction technique using lateral upper arm free flaps and review the surgical outcome in patients with severe orbital soft-tissue loss and contracted eye sockets.Twenty-four patients with severe orbital soft-tissue loss and contracted eye sockets were included in this study. A free flap from the lateral upper arm of the patient was inserted into the eye socket, with the artery and vein of the flap pedicle attached to the ipsilateral superficial temporal artery and vein, respectively. Eye socket reconstruction was performed 2 weeks after the first operation. Patients were fitted with a piece of prosthesis 3 months later. Most patients needed a second operation for eyelid and eye socket reconstruction, including lower eyelid laxity and retraction correction, medial and lateral canthoplasty, and upper or lower fornix reconstruction.Postoperative improvement in appearance was evaluated, including texture and color of the flaps, sensation and mobility of the forearm and elbow, and visibility of the surgical scar. All 24 patients were followed up for 6 months to 5 years. Donor sites healed with linear scars, and no sensory or movement loss was found in any of the patients. The reconstructed area appeared good, patients were satisfied with recovering results, and the prosthesis fit well.The skin from the lateral upper arm has consistent blood vessels and suitable thickness to serve as a source for orbital soft-tissue and contracted eye socket reconstruction, with good cosmetic outcomes.Therapeutic, IV.
Fornix
Ocular prosthesis
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Contracted eye socket is a constant cosmetic embarrassment to the patient. It does not only render patients unable to maintain eye prosthesis, but it becomes a source of chronic discharge and irritation. Traumatic injuries to the orbit and neighboring soft tissue lead to a contracted eye socket. To evaluate the use of full thickness and thick split thickness skin graft in the reconstruction of contracted eye socket with achieving satisfactory cosmetic results we used bilateral fish tail incision in continuity with the transverse incision on the back of the eye socket for rising of two unipedicle hinge flaps for creation of upper and lower fornices. Fixation of full-thickness and thick split-thickness skin graft to the created raw area by stitch and splint (non-adherent tulle and eye prosthesis).Twenty-six patients with contracted eye sockets treated with above method from February, 2004 to March, 2005. Eye sockets with adequate size were created in 22 patients and the results were satisfactory, four patients had unsatisfactory results due to partial loss of the full thickness skin graft. We believe that thick split thickness skin graft can be effectively used well than full thickness skin graft in the reconstruction of the contracted eye socket with uncomplicated problems.
Ocular prosthesis
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Anophthalmia
Ocular prosthesis
Enophthalmos
Orbit (dynamics)
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Anophthalmia
Eye Enucleation
Retinoblastoma
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Objective To observe the clinical effects of orbital implant in ocular socket plasties.Methods Four patients were implanted with MEDPOR orbital implant bases folloving eyeball enucleating or eye eviscerating.Nine patients were secondary implantation.Three to six months after operation,drilling operation was performed.Results In 6～12 months of follow-up,there was no extrusion in the group.In one case dehiscence happened after operation,and satisfied result was achieved after repaired with temporal parietal fascia.The appearance and motility was satisfactory in 10 cases.In one case light enophthalmic socket was seen.Conclusion MEDPOR is natural occurring material as a foreign substance.There are few complications.It is considered that MEDPOR implant is made of one of the best materials and this method is one of the best ocular socket plasty for selection.
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Fornix
Orbit (dynamics)
Tarsus (eyelids)
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To evaluate the effect of correcting complex deformity of the orbital region and contraction of the eye socket that caused by enucleation and postoperative irradiation for the treatment of retinoblastoma.Depressive deformity of the orbitozygoma was corrected, and a large permanent eye socket was achieved in two-stage operation. First-stage surgery: Orbitozygomatic deformity reconstruction with hydroxyapatite (HA) and a temporoparietal fascial flap and a HA implant for correction of anophthalmos. Second-stage: Free radial forearm flap was adopted for eye socket reconstruction.Excellent cosmetic results of this method in 8 cases were demonstrated.This method is effective for management of complex deformities of orbitozygoma and contraction of eye socket.
Retinoblastoma
Facial deformity
Eye Enucleation
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The functional and esthetic results of reconstructive surgery after extended total maxillectomy or extended orbital exenteration greatly depend on the quality of the orbital reconstruction. We developed dynamic eye socket reconstruction using temporalis transfer to achieve good orbital reconstruction, and examined the usefulness of our technique. Five patients (three men and two women, aged 44–72 years) who underwent extensive resection of midfacial malignancies were treated with dynamic eye socket reconstruction using temporalis transfer. In most cases, eye socket reconstruction was performed approximately 1 year after the initial surgery, and temporalis transfer was used after maturation of the eye socket. The follow-up period ranged from 16 to 120 months (average 63.8 months). Movement of the upper and lower eyelids was achieved in all cases, and definite creases at the lateral canthus were observed in two patients. A good shape in the reconstructed medial and lateral canthal areas was maintained in all patients. Our reconstruction technique is extremely effective in creating natural creases (‘crow’s feet’) at the lateral canthus during smiling, enabling movement of the upper and lower eyelids, and maintaining a sharp palpebral morphology.
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The aim of article was to describe two possibilities of reconstruction of contracted and deformed conjunctival socket at the patient undergoing enucleation of the eye many years ago.The free full-thickness mucosa graft was used in local anaesthetic for reconstruction conjunctival socket at the first patient. The amnion membrane was used in the second case with correction of ectropion of lower eyelid.The good cosmetic and stabile effect was obtained in both cases.
Ectropion
Amnion
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