The Osseointegration Technique for the Rehabilitation of the Exenterated Orbit

Nerad, Jeffrey A.; Carter, Keith D.; LaVelle, William E.; Fyler, Ann; Brånemark, Per‐Ingvar

doi:10.1001/archopht.1991.01080070144054

Cited by 56 publications

(20 citation statements)

References 11 publications

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“…[25][26][27][28][29][30][31][32][33][34] In this series the majority of reconstruction was done with split thickness skin grafting, as our institute typically uses this technique for exenteration when done alone. 35 In cases of extended orbital exenteration involving bone removal, flaps are more commonly used at our institute and there were four cases of local/regional flaps, and nine free flaps done for cases of extended orbital exenteration.…”

Section: Discussionmentioning

confidence: 99%

Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival

Gerring

Ott

Curry

et al. 2016

Eye

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Purpose To describe prognostic factors and survival outcomes in patients who underwent orbital exenteration for periocular nonmelanoma cutaneous malignancies. Methods The authors performed an institutional review board-approved retrospective review of all patients who underwent orbital exenteration for nonmelanoma periocular cutaneous malignancies at a tertiary care hospital system over a 10-year period. Patient demographics, tumor, and treatment data were recorded. Survival outcomes included disease-free survival (DFS) and overall survival (OS). Log-rank tests were used to test for difference in survival curves among various potential prognostic indicators, and multivariate analysis was performed using Cox's proportional hazards model. Results Forty-nine patients with an average age of 70.3 years were followed with a median follow-up of 17.5 months. At 2 years the OS was 78% while the DFS was 61%. The mean DFS for basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and sebaceous gland carcinoma (SGC) were 52.6, 39.2 and 28.1 months, respectively. Multivariate analysis demonstrated that only positive final surgical margin was predictive of worse outcome (P = 0.002). Recurrences were most frequent in the first 2 years. Conclusions Despite the relatively more aggressive nature of periocular malignancies that have invaded the orbit, orbital exenteration offers an overall 2-year DFS of 60%. BCC had the greatest mean survival time, however this was not statistically significant. We found worse prognosis with positive final surgical margins and recommend a multidisciplinary surgical approach to achieve complete resection when indicated.

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Section: Discussionmentioning

confidence: 99%

Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival

Gerring

Ott

Curry

et al. 2016

Eye

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“…44 The technique was pioneered by Brånemark in Sweden and it has proven to be a very successful method of fixation for facial and other prostheses.…”

Section: Eyementioning

confidence: 99%

“…About 4 months later, the skin over the implants is opened, healing of the skin around the implant is allowed to occur, and then the final magnets or framework for prosthesis fixation are fitted (Figure 1). The mould of the socket is taken at this stage and the prosthesis is made 44,45 (Figure 2). Osseointegration also occurs in irradiated orbits, but it is less reliable and it is advisable to delay implantation for at least a year following irradiation.…”

Section: Eyementioning

confidence: 99%

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Orbital exenteration for invasive skin tumours

Tyers

2006

Eye

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Orbital exenteration aims at local control of disease invading the orbit that is potentially fatal or relentlessly progressive. Of all exenterations presenting to ophthalmologists, 40-50% are required for tumours in the eyelid or periocular skin. 99% of these are basal cell carcinomas and 4-6% each are squamous cell carcinomas or sebaceous gland carcinomas. Orbital invasion results in progressive fixation of the tumour to bone and reduced ocular motility. Perineural invasion of branches of the trigeminal nerve leads to numbness or pain, and that the facial nerve, to weakness. Biopsy identifies the cell type and the presence of perineural invasion. CT and MRI scanning help in the assessment of tumour spread within the orbit. Management should be in collaboration with an oncologist. Exenteration may be totalthe removal of all orbital contents-or lidsparing if the tumour is placed posteriorly. The socket may be allowed to heal by granulation or lined with a split skin graft or local flap. Complications may be seen following 20-25% of exenterations and include fistulae, tissue necrosis, exposed bone, and infection. Incomplete clearance of tumours occurs in about 38% of total exenterations and 17% of subtotal. The overall 5-year survival is 55-65%, but significantly worse if there was perineural spread. Facial prostheses may be mounted on glasses or secured with tissue glue or osseointegrated implants. Excellent cosmetic results can be achieved but many patients prefer to wear a patch.

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“…Tailored exenteration with lid-sparing surgery, 12 where possible, and the use of skin/muscle flaps, 13 split skin grafts, and osseointegrated orbital implants 14 have improved cosmetic outcomes, although most patients still prefer a patch! 15 Thyroid eye disease involves an inflammatory response with deposition of GAG in the orbit causing orbital congestion and proptosis.…”

mentioning

confidence: 99%

Cosmetic orbital surgery

Lane

2006

Eye

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Purpose Current indications for orbital surgery primarily aimed at improving cosmesis are considered in the context of subspecialist orbital practice by an ophthalmologist. Scope Thyroid eye disease, orbital vascular anomalies, and dermolipomas are common orbital diseases in which the symptoms can be purely cosmetic. Accurate anatomical awareness, preoperative scanning, control of medical factors including smoking and thyroid status, and endoscopic techniques have all contributed to the aesthetic outcome of orbital surgery. The threshold for performing reconstructive orbital surgery has also been lowered by public demand. Conclusions Orbital surgeons can therefore offer the familiar techniques, such as orbital decompression, for pure cosmesis. Sensitive history taking and awareness of the psychological element are of paramount importance for the orbital surgeon who develops a cosmetic practice.

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The Osseointegration Technique for the Rehabilitation of the Exenterated Orbit

Cited by 56 publications

References 11 publications

Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival

Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival

Orbital exenteration for invasive skin tumours

Cosmetic orbital surgery

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