Reabilitação com prótese oculopalpebral após exenteração de órbita: relato de caso / Rehabilitation with oculopalpebral prosthesis after orbit exenteration: a case report / Rehabilitación com prótesis oculopalpebral después de la exenteración de la órbita: reporte de un caso

Introdução: A ressecção cirúrgica de tumores em região de cabeça e pescoço é um tratamento eficaz, mas que implica em significativa desfiguração facial dependendo da localização da lesão. Aqueles pacientes considerados curados precisam ser reabilitados estética e funcionalmente para que possam ser reintegrados às funções sociais. A prótese maxilofacial é um artefato de baixo custo, que pode resolver essa necessidade. Relato de caso: Esse artigo relata o caso de uma paciente de 19 anos submetida à exenteração de órbita para tratamento de Tumor Fibroso Solitário Retrorbitário que, após a cirurgia e radioterapia adjuvante, foi reabilitada por meio de prótese óculopalpebral em silicone. Conclusão: O caso foi considerado um sucesso e ressalta a importância do cirurgião dentista na equipe oncológica e o positivo impacto psicológico e social da reabilitação(AU)

Introduction: Surgical resection of head and neck tumors is an effective treatment, but it implies significant facial disfigurement depending on the location of the lesion. Those patients considered cured need to be rehabilitated aesthetically and functionally so that they can be reintegrated into social functions. The maxillofacial prosthesis is an artifact of low cost, which can solve thisneed. Case Report: This article reports the case of a 19-year-old patient who underwent orbit exanteration for the treatment of Solitary Retrorbital Fibrous Tumor, which, after surgery and adjuvant radiotherapy, was rehabilitated using an oculopebral prosthesis made of silicone. Conclusion: The case was considered a success and highlights the importance of the dental surgeon in the oncology team and the positive psychological and social impact of rehabilitation(AU)

Introducción: La resección quirúrgica de los tumores de cabeza y cuello es un tratamiento eficaz, pero implica una desfiguración facial significativa según la ubicación de la lesión. Aquellos pacientes considerados curados necesitan ser rehabilitados estética y funcionalmente para que puedan reintegrarse a las funciones sociales. La prótesis maxilofacial es un artefacto de bajo costo que puede resolver esta necesidad. Reporte del caso: Este artículo informa el caso de una paciente de 19 años que se sometió a una exenteración de órbita para el tratamiento del tumor fibroso retrorbital solitario, que, después de la cirugía y la radioterapia adyuvante, fue rehabilitada con una prótesis oculopalpebral de silicona. Conclusión: El caso se consideró un éxito y destaca la importancia del cirujano dental en el equipo de oncología y el impacto psicológico y social positivo de la rehabilitación(AU)

Combination of skin flap and silicone prosthesis for rehabilitation of a large orbital defect: A case report.

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.

Estudio comparativo de los hallazgos clínicos en la enfermedad orbitaria asociada a IgG4 con afectación unilateral vs. bilateral / Comparative study of clinical features between unilateral and bilateral orbital IgG4-related disease

OBJETIVO: Análisis descriptivo y comparativo de los pacientes diagnosticados de enfermedad orbitaria asociada a IgG4. MATERIAL Y MÉTODOS: Se revisaron y analizaron todos los casos diagnosticados de inflamación orbitaria asociada a IgG4 por el servicio de Patología del Hospital Dr. Luis Sánchez Bulnes. RESULTADOS: Encontramos un total de 9 casos. El 66% fueron mujeres, con una edad media de 48 años y tiempo medio de evolución al diagnóstico de 2 años. El 56% de los casos presentaron afectación unilateral: el 100% eran mujeres con clínica de dolor al ingreso y una respuesta óptima al tratamiento corticoideo en el 100% de los casos que precisaron tratamiento médico (un caso mostró resolución espontánea). En los casos bilaterales (44%) solo el 25% fueron mujeres y ninguno refirió dolor como síntoma de presentación. Además, el 25% de estos pacientes precisó de la combinación con inmunosupresores para conseguir el control del cuadro. CONCLUSIONES: La presentación clínica de los pacientes con inflamación orbitaria asociada a IgG4 difiere según sea una afectación uni- o bilateral

OBJECTIVE: Descriptive and comparative study of patients with orbital IgG4-related disease. MATERIAL AND METHODS: A review and analysis of the cases diagnosed with inflammatory orbital lesion related to IgG4 by the Ophthalmic Pathology Service in the Dr. Luis Sánchez Bulnes Hospital. RESULTS: A total of 9 cases were found, in which 66% were women, and with a mean age of 48 years and time to diagnosis of 2 years. Unilateral involvement was observed in 56% of cases. All the females experienced pain, and there was an optimal response to corticosteroid treatment in 100% of patients who required medical treatment (one case showed spontaneous resolution). In bilateral cases (44%), only 25% were female, and none had pain as a presenting symptom. Furthermore, 25% of these patients required a combination with immunosuppressants to control inflammation. CONCLUSIONS: Clinical presentation of patients with unilateral orbital IgG4-related disease differs from those with bilateral involvement

Fabrication of an immediate surgical obturator for a patient with resection of the maxillary antrum and bony orbital floor.

An immediate surgical obturator is necessary for maxillectomy procedures to minimize functional disabilities in speech, swallowing, and egress of food and liquid into the surgical defect. Sometimes the extent of the tumor may be such that it may even require the removal of the maxillary sinus along with resection of the orbital floor. The resected orbital floor can be surgically reconstructed with autogenous soft and/or hard tissues or with alloplastic materials. This clinical report highlights one such situation where the surgical resection of the maxilla and the orbital floor were rehabilitated with an immediate surgical obturator extending to the orbital floor to support the visual apparatus.

[Early surgical rehabilitation due to modified exenteration technique]. / Frühe chirurgische Rehabilitation durch modifizierte orbitale Exenteration.

BACKGROUND: Orbital exenteration is a life intruding surgical procedure with severe functional, aesthetic and psychological consequences. Apart from the correct tumor treatment, early aesthetic and psychosocial rehabilitation is crucial for the well-being of the patient. We discuss reasons leading to exenteration and present new surgical techniques. Local flaps in the anterior socket improve wound healing allowing early placement of the prosthesis and therefore faster social rehabilitation of the patient. PATIENTS AND METHODS: Between 2007 and 2011 seven patients with malignant orbital tumors (1 × plasmocytoma, 1 × melanoma, 1 × sarcoma, 1 × squamous cell carcinoma and 3 × basal cell carcinoma) received a radical orbital exenteration at the Department of Ophthalmology of the Zurich University Hospital. The medical histories were evaluated according to reasons for exenteration, surgical techniques and postoperative follow-up. Reconstruction of the anterior socket border succeeded using local flaps (Mustardé, Glabella and combined with further modified pedicled local full thickness skin flaps). The central defects were covered with split skin graft from the thigh. RESULTS: Three weeks after surgery the anterior border of the socket was completely healed without problems by local flaps with good blood supply. This allowed the early prosthetic fitting and wearing as well as quick social rehabilitation of the patient. CONCLUSIONS: The use of local flaps improves wound healing even in anticoagulated patients. This reduces the time of hospitalization and rehabilitation, and allows an early, satisfactory, social reintegration of the patient.

Prosthetic rehabilitation of a patient with adenoid cystic carcinoma with continuous orbital-maxillary defect.

Extensive head and neck surgical procedures severely affect vital functions, physical appearance and lead to huge psychological trauma in the patients. Well-constructed maxillofacial prosthesis will help them lead a normal social life for the remaining precious time. This case report explains the prosthetic rehabilitation of continuous orbital-maxillary surgical defect in a patient with adenoid cystic carcinoma with restricted mouth opening. Maxillofacial prosthesis needs individual modification to a treatment plan according to the defect and existing clinical conditions. In this case, magnetically retained three-piece prosthesis was designed because of high recurrence rate of the adenoid cystic carcinoma, lack of adequate bone for implants and limited mouth opening in the patient. The prosthesis restored the phonetics, aesthetics and deglutition of the patient by re-establishing the separation of oral-nasal-orbital cavities.

Porous polyethylene implant reconstruction of the orbit after resection of spheno-orbital meningiomas: a novel technique.

BACKGROUND: Spheno-orbital meningiomas (SOM) are complex tumors involving the middle cranial fossa and orbit. Following resection of these tumors, reconstruction of the orbit can be challenging. Inadequate reconstruction may lead to cosmetic deformities and functional complications. OBJECTIVE: The development of a technique for orbital reconstruction which is technically straightforward, cost-effective, with an excellent functional and cosmetic outcome. TECHNIQUE: Twelve patients with SOM each underwent a modified orbital-zygomatic craniotomy with osteotomies based on individual tumor location. After tumor resection, the lateral orbit and orbital roof, where necessary, were reconstructed using a 1 mm porous polyethylene sheet, customized to reconstruct the bony anatomy of the lateral and superior orbit and secured with 1.5×4 mm titanium screws into the orbital roof and rim. RESULTS: All patients demonstrated stabilization or improvement of vision and satisfactory cosmetic outcomes. One complication (surgical site infection) was noted. Follow-up imaging was obtained at regular intervals. The resection cavity was easily visualized without interference from the implant in each case. One patient developed tumor recurrence requiring re-operation 20 months after the initial procedure. CONCLUSIONS: Use of a 1mm porous polyethylene sheet for reconstruction of the lateral orbit offers an excellent functional and cosmetic outcome, does not interfere with postoperative imaging, is technically straightforward, and is cost-effective.

Prosthetic rehabilitation.

Patients with head and neck defects may undergo reconstruction surgically, prosthetically, or with a combined approach. In some situations, prosthetic rehabilitation may be the preferred treatment option. Presurgical treatment planning and evaluation of the patient is paramount to successful reconstruction and rehabilitation. Patient education and assessment of the patient's expectations are essential in the acceptance of a proposed treatment plan. Communication and joint treatment planning early in the process between the surgeon and maxillofacial prosthodontist will optimize results.

Extraoral prostheses using extraoral implants.

The aim of this study was to evaluate extraoral prostheses and the use of extraoral implants in patients with facial defects. 10 cases were treated utilizing maxillofacial prostheses employing extraoral implants in five cases. 16 extraoral implants were installed. Seven implants were placed in irradiated sites in the orbital regions. Six implants were placed in mastoid regions and three in a zygoma region that was irradiated. Two implants failed before initial integration was achieved in irradiated areas. Using 14 extraoral implants as anchors, five extraoral prostheses were set. The other five cases were treated with extraoral prostheses without using extraoral implants due to cost and patient-related factors. The data included age, sex, primary disease, implant length, implant failure, prosthetic attachment, radiation therapy, and peri-implant skin reactions. The use of extraoral implants for the retention of extraoral prostheses has simplified the placement, removal, and cleaning of the prosthesis by the patient. The stability of the prostheses was improved by anchors. Clinical and technical problems are presented with the techniques used for their resolution. Using extraoral implants resulted in a high rate of success in retaining facial prostheses and gave good stability and aesthetic satisfaction.

Reconstruction of the orbital floor after its removal for malignancy.

Reconstruction of the orbital floor for malignant disease can be difficult. The tissue used should replace the floor itself and the orbital rim to ensure appropriate positioning of the globe and to avoid ectropion. The authors present a simple technique using temporalis muscle with attached coronoid process of the mandible that covers both these areas, and which is suitable for most defects in this area.

Computer-generated patient models for reconstruction of cranial and facial deformities.

The use of three-dimensional, computer-generated anatomic models can be used in the diagnosis and reconstruction of a variety of craniofacial problems. They are readily manufactured from computed tomography scans at a reasonable cost with only several weeks of preparation and delivery time. Their contemporary value is in the preoperative treatment planning, intraoperative implant fashioning, and preoperative implant fabrication in appropriately selected patients.

A CAD/CAM technique for fabricating facial prostheses: a preliminary report.

A computer-aided designing and manufacturing (CAD/CAM) technique for clinical fabrication of facial prostheses was developed. Laser surface scanning was applied to acquire three-dimensional imaging data of the patient's facial defect. The three-dimensional imaging data was then transferred to a CAD/CAM interactive program for image processing, which then mathematically designed and produced a model for fabrication of the facial prosthesis. This CAD/CAM technique has the potential to simplify the procedure and decrease the laboratory work required compared to that required for the conventional plaster-cast method. This new technique also provides a novel approach to the fabrication of prostheses for the reconstruction of facial defects. Two alternative three-dimensional modeling processes, laser lithographic modeling and numerically controlled milling modeling, were integrated in this study. The possibilities and current limitations of the techniques are also discussed.

Modified bar superstructure for an implant-retained orbital prosthesis.

The success of a bar superstructure for an orbital prosthesis may be compromised by the placement and angulation of implants. The following technique describes a modification to a bar superstructure that provided the advantages of convenience, security, and consistent positioning even though one implant was lost and the angulation of implants limited accuracy.

The temporalis muscle flap: an evaluation and review of 38 cases.

This article analyzes the authors' experience with the temporal myofascial flap in orbital, maxillary, floor of the mouth, tongue, retromolar trigone, and buccal mucosa reconstruction after oncologic surgery. Thirty-eight patients were treated and evaluated after using this technique. Four of the patients received the flap to restore orbital defects; the other 34 flaps were used in oral reconstruction. The flap remained viable in all instances. Most of the patients experienced no perioperative complications. Ten patients (29.4%) with flaps transposed to the oral cavity showed partial wound dehiscence. Two patients experienced temporomandibular joint dysfunction, two severe reduction in the oral aperture, 22 had mild depression of the temporal fossa, and four had mild to severe alteration in the facial aesthetics secondary to bone resection. All flaps transposed to the oral cavity showed good epithelialization and adaptation to the recipient site.

Surgical and prosthetic considerations in the management of orbital tumors.

Since tumors of the globe and ocular adnexa, other than skin cancers of the eyelid, are uncommon, most oncologic specialists have little opportunity to become experienced in the management of eye tumors. In general, a malignancy that does not penetrate a bony orbital wall can be resected with an adequate margin by inclusion of the adjacent wall and periorbita. The decision to save or sacrifice a globe when a malignancy penetrates the bone but not the periorbita should be based on such factors as the tumor histology, contralateral vision, the probability of permanent diplopia, and the need for irradiation in doses that would destroy vision. Because of the complications involved with irradiation of orbital tumors, surgical resection has been the treatment of choice. In addition, orbital exenteration presents a unique challenge to the maxillofacial prosthodontist. Prosthetic restoration of the orbit is often complicated by the extent of resection, tissue response, and method of retention.