Orbital Prostheses
The loss of an eye is devastating, the loss of an eye together with surrounding facial structures doubly so. The relatively new field of anaplastology now allows the patient to be rehabilitated with a realistic orbital and facial custom-made prosthesis. T
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Paul Tanner and Bhupendra C. K. Patel
Introduction An increase in the average life span has resulted in an increased incidence of malignant skin tumors of the face and eyelids. This has led to the increase in the rate of exenteration. Orbital exenteration includes the removal of the globe, extraocular muscles, adipose tissue, and optic nerve to the optic foramen (Chap. 18) [1, 2]. Traditionally, exenterations in ophthalmology are divided into four types based upon the 1971 Meyer and Zaoli’s classification [3] and based upon the extent of destruction involved in the surgery: • Type I: palpebral skin and conjunctiva are spared. • Type II: only the palpebral skin is spared, and the eyeball and its appendages are removed with the conjunctiva. • Type III: both eyelids are removed with orbital contents. • Type IV: the eyeball, eyelids, and appendages of the eye are removed with the involved bone structures.
P. Tanner Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT, USA B. C. K. Patel (*) Division of Facial Cosmetic and Reconstructive Surgery, University of Utah, Salt Lake City, UT, USA e-mail: [email protected] © Springer Nature Switzerland AG 2019 C. J. Hwang et al. (eds.), Clinical Ophthalmic Oncology, https://doi.org/10.1007/978-3-030-13558-4_22
However, as clear margins of tumor resection are sought with modern oncological approaches, exenteration may extend to other facial structures including the forehead, cheeks, nose, and lower face, requiring the creation of the field of anaplastology (Gr kana, anew; plastos, molded; logy, the study of) with a particular emphasis on facial prosthetic design. An external facial prosthesis for orbital exenteration is called an orbital prosthesis when solely involving the soft tissue of the orbit. An upper facial prosthesis restores the orbit in addition to portions of the frontal or zygomatic bones. A hemifacial prosthesis restores the orbit in addition to portions of the nose or maxillary bone. Orbital, upper facial, and hemifacial external prostheses will all be referred to as orbital prostheses in this chapter [4, 5].
Pre-exenteration Decision-Making Not all oncology or trauma patients receive a realistic prosthesis for an exenterated orbit even though the prosthesis is the most natural reconstructive method. Availability and access to quality orbital prostheses are important for the patient to decide between an eye patch or orbital prosthesis. When a patient is presented for an orbital exenteration, the patient should be informed of the available reconstruction options. It must be clearly understood that the eye cannot be surgically reconstructed and the 289
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loss of the eye will result in the loss of depth perception, smaller field of view, and other issues related to monocular vision [6]. If possible, the patient also needs to know before the exenteration about long-term care and cleaning related to the surgery. The surgery can result in exposed sinuses and mucosa which can result in excessive exudate
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