One of the greatest advances in the understanding of wound healing was the identification and characterization of the myofibroblast by Gabbiani in 1971. Since that time this contractile cell has been found in the early s...One of the greatest advances in the understanding of wound healing was the identification and characterization of the myofibroblast by Gabbiani in 1971. Since that time this contractile cell has been found in the early stages of wound healing and in many pathologic states. In a recent study, the myofibroblast was found in healing and contracting anophthalmic sockets.
Two cases of congenital symblepharon (variant of cryptophthalmos) are reported. Cryptophthalmos is a very rare congenital defect, with incomplete or complete failure in the development of one or both eyelids with skin re...Two cases of congenital symblepharon (variant of cryptophthalmos) are reported. Cryptophthalmos is a very rare congenital defect, with incomplete or complete failure in the development of one or both eyelids with skin recovering the anterior segment. Surgical treatment is described including expansion of the conjunctival fornix with eyeball conservation if possible. At the same time or later, the upper eyelid is reconstructed by inferior eyelid flap. The ophthalmic features of cryptophthalmos and its systemic associations are reviewed.
In patients with congenital anophthalmos and severe microphthalmos, a tiny orbit and socket exist with little eyelids, frequently preventing retention of a standard conformer or prosthesis. Socket expansion is sometimes...In patients with congenital anophthalmos and severe microphthalmos, a tiny orbit and socket exist with little eyelids, frequently preventing retention of a standard conformer or prosthesis. Socket expansion is sometimes impossible with microorbitism; the retention of a prosthesis is also difficult when malformations of the eyelids exist. The treatment of these difficult cases includes three stages. The first stage is orbital expansion that depends on the cephalometric studies of the patient: transverse osteotomy on the maxilla and the zygomatic bone with lateral bar by extracranial route, vertical osteotomy on the roof of the orbit by intracranial route. In some cases, the osteotomy includes expansion in the transverse and vertical diameter with bone grafts in the defects and on the lateral and superior rims. Simultaneously, socket expansion is performed by incision of the conjunctival sac circumferentially, with mucosal or split skin grafts on a conformer. The second stage includes eyelid reconstruction by different flaps. A third stage is frequently needed for correction of eyelid malposition on the prosthesis: ptosis, entropion surgery. Two cases of congenital anophthalmos are reported. Methods and indications of treatment are discussed.
An expansion prosthesis has been developed for the anophthalmic or microphthalmic socket. Orthodontic wire covered with silicone tubing is fused onto a conventional methyl-methacrylate ocular prosthesis. The use of this...An expansion prosthesis has been developed for the anophthalmic or microphthalmic socket. Orthodontic wire covered with silicone tubing is fused onto a conventional methyl-methacrylate ocular prosthesis. The use of this device is illustrated in a case report.
The congenitally contracted socket often poses a challenging management problem; early surgery may be necessary in spite of the attendant difficulties. A series of patients is presented, with particular emphasis upon the...The congenitally contracted socket often poses a challenging management problem; early surgery may be necessary in spite of the attendant difficulties. A series of patients is presented, with particular emphasis upon the use of a new hydrophilic expander in the severely contracted socket, to illustrate our current management protocol. Factors pertinent to orbital development and growth are discussed. Two types of contracted sockets are identified that appear to correlate with the presence or absence of an eye or ocular remnant. Use of a hydrophilic expander in the severely contracted anophthalmic socket with marked lid phimosis has enabled subsequent fitting and retention of a hard conformer in many of these cases, thus obviating early interventional surgery.
Early socket stimulation is crucial for management of congenital anophthalmos and microphthalmos among infants. Progressive sized hard conformers and lid expansion devices can expand the small socket in these patients. T...Early socket stimulation is crucial for management of congenital anophthalmos and microphthalmos among infants. Progressive sized hard conformers and lid expansion devices can expand the small socket in these patients. The ocularists' management of these two conditions is discussed and techniques are introduced.
The replacement of any anatomic structure by artificial means remains a challenge. This is particularly true in the facial area. The replacement must be one which blends with the adjacent tissues as well as replaces the...The replacement of any anatomic structure by artificial means remains a challenge. This is particularly true in the facial area. The replacement must be one which blends with the adjacent tissues as well as replaces the missing structures. Careful planning and meticulous attention to detail in fabrication of a prosthesis can enable the maxillofacial prosthodontist to make a major contribution in the rehabilitation of the patient with an orbital defect.
Primary to the development of an acceptable and functional facial prosthesis is the impression procedure. The fabrication of a facial prosthesis combines the art and science of anatomy, cosmesis, and function, to develop...Primary to the development of an acceptable and functional facial prosthesis is the impression procedure. The fabrication of a facial prosthesis combines the art and science of anatomy, cosmesis, and function, to develop a nonliving substitute to replace altered, missing, or defective regions of the head and neck area. Success depends on patient's cooperation, motivation, and commitment to treatment as well as the technical and artistic scope of the facial prosthetic service.
Three dimensional images reconstructed from two dimensional CT scans allow improved analysis of complex orbitocranial bony deformities. This evaluation may be useful in patients with defects resulting from trauma, tumor,...Three dimensional images reconstructed from two dimensional CT scans allow improved analysis of complex orbitocranial bony deformities. This evaluation may be useful in patients with defects resulting from trauma, tumor, congenital abnormalities, or developmental disorders. Diagnosis, surgical management, and long-term follow-up evaluation may be aided by improved understanding of bony contour and volume analysis. Computer designed prostheses can be fabricated to precisely match bony defects and may be used as an alloplastic implant or as a model to aid intraoperative contouring of an autogenous bone graft. The limitations of three dimensional imaging include artifacts in the reconstructed images, increased radiation exposure, and increased cost. The technology is still evolving and the indications and benefits remain undefined at the present time.
This paper includes the historical development of the modern-day facial prosthesis, the various materials used from the early days to the present, and the historical input of various people and their contributions toward...This paper includes the historical development of the modern-day facial prosthesis, the various materials used from the early days to the present, and the historical input of various people and their contributions towards the development of the qualities in fabricating a lifelike facial prosthesis.
A technique using the frontalis muscle to reconstruct the exenterated orbit is described. The technique is simple and does not leave a depression in the temporalis fossa.A technique using the frontalis muscle to reconstruct the exenterated orbit is described. The technique is simple and does not leave a depression in the temporalis fossa.
The authors describe the techniques for subtotal, total and radical orbital exenteration. The aspects of primary and late reconstructive surgery are also discussed, with special reference to Frezzotti's personal techniqu...The authors describe the techniques for subtotal, total and radical orbital exenteration. The aspects of primary and late reconstructive surgery are also discussed, with special reference to Frezzotti's personal technique for temporalis muscle transplantation after subtotal exenteration.
Indications for the mutilating operation of exenteration are enumerated. They usually involve a malignant neoplasm of the orbital contents, primary, direct extension, or adnexal tissue that cannot be controlled by simple...Indications for the mutilating operation of exenteration are enumerated. They usually involve a malignant neoplasm of the orbital contents, primary, direct extension, or adnexal tissue that cannot be controlled by simple excision or irradiation. Surgically, subtotal exenteration with partial preservation of lids and even conjunctiva may be achieved occasionally. However, total exenteration may be lifesaving. Techniques and precautions are discussed. Advantages and disadvantages of skin grafting that influence the post-operative care are noted.
Based on the pathology of the eye socket and periorbital deficiencies, three distinct classes of patients can be recognized: I. Those who solely have eye socket deficiency with normal orbital and periorbital tissue. The...Based on the pathology of the eye socket and periorbital deficiencies, three distinct classes of patients can be recognized: I. Those who solely have eye socket deficiency with normal orbital and periorbital tissue. The suggested surgical treatment for this class of patient would be a skin or mucosa graft. II. Patients who have inadequate lining, as well as orbital volume deficiency. The preferred reconstructive approach includes cartilage (rib or ear) with or without fat graft, and skin or mucosa grafts for eye socket expansion. III. For failed reconstructions of classes I and II or for patients with severe orbital and periorbital deficiencies, the choice is one of three flaps: If the superficial temporal vessels and the postauricular skin is intact, the ideal flap is postauricular fasciocutaneous. If the postauricular skin has previously been used yet the superficial vasculature is intact, a secondary flap is the better choice. In cases where both postauricular skin and superficial temporal vessels have been sacrificed the recommended flap is a free flap with microvascular anastomosis.
Autogenous dermis-fat grafts implanted within the orbit survive best, with little loss of volume, when they are placed within Tenon's capsule immediately following the removal of the globe; when the rectus muscles (and a...Autogenous dermis-fat grafts implanted within the orbit survive best, with little loss of volume, when they are placed within Tenon's capsule immediately following the removal of the globe; when the rectus muscles (and anterior ciliary arteries) are anastomosed to the dermal edge of the graft; when no cautery has been applied to the recipient bed; and when the anterior diameter of the graft is no larger than 22 mm. Primary grafting in patients without systemic vascular disease is more effective than secondary procedures, performed on patients with fibrotic, compromised recipient beds and without direct apposition of the rectus muscles to the graft.
The treatment of severely contracted sockets represents one of the most difficult situations in ophthalmic plastic and reconstructive surgery. In particular, the treatment of the postirradiated socket has been considered...The treatment of severely contracted sockets represents one of the most difficult situations in ophthalmic plastic and reconstructive surgery. In particular, the treatment of the postirradiated socket has been considered "hopeless surgery." In recent years a modified approach to this problem has been tried, in which the use of the temporalis muscle provided a well-vascularized bed for delayed reconstructions.
Facial asymmetry and cosmetic deformity can occur following enucleation. The effect of enucleation on the growth of the orbit can be demonstrated in the rabbit and cat by early enucleation, X-ray study and dry skull meas...Facial asymmetry and cosmetic deformity can occur following enucleation. The effect of enucleation on the growth of the orbit can be demonstrated in the rabbit and cat by early enucleation, X-ray study and dry skull measurements. In 42 human patients the anophthalmic orbital changes are determined by roentgenograms. The influencing factors of age and the use of implants are discussed as to changes in the rim, orbital walls and volume, and optic foramina measurements. Growth retardation due to roentgen ray therapy and other clinical aspects are considered which would influence the appropriate clinical management.