Prosthetic rehabilitation of orbital defects: A review of 110 cases.

Abstract

Objective: Debilitating orbital defects can arise as a part of tumor management, trauma, and congenital malformations. Due to limitations in surgical reconstruction, ideal aesthetic results may not be achieved. The reconstruction of orbital defects mostly comprises of placement of a skin graft or rotational flaps to close the area. Facial prosthesis is a preferred alternative, where a more controllable and predictable aesthetic outcome can be obtained. Materials and methods: In this retrospective study, a group of 110 patients who had been rehabilitated with silicone orbital prostheses in the Maxillofacial Prosthetic Service, Mahidol University between 2000-2011 was taken into consideration. The most common defect etiologies, surgical and prosthetic treatment employed, and frequently encountered problems following rehabilitation were evaluated. Results: Out of 98 patients eligible for the study, 88 patients were treated with adhesive retained prostheses and 10 were treated with implant-retained prostheses. The etiologies that resulted in orbital defects were tumor (86.7%), fungal infection (7.1%) and trauma (6.1%). Tumors with the highest incidence were retinoblastoma (29.4%), squamous cell carcinoma (25.9%), adenocystic carcinoma (11.8%), and others such as basal cell carcinoma, malignant melanoma, etc. Orbital defects established following removal of the tumor by exenteration (71.4%), enucleation (24.5%), and trauma (4.1%). Commonly encountered problems after rehabilitation were discoloration of the prosthesis, open or torn margins, and acrylic housing dislodgment. Conclusion: The use of silicone prosthesis can be a safe, predictable and aesthetic treatment option for rehabilitation of orbital defects. However, focus on patient awareness, early detection, and intervention should be emphasized so that the individuals can be spared from these debilitating conditions.