Closed-eye orbital prosthesis: A clinical report

https://doi.org/10.1016/j.prosdent.2014.07.018Get rights and content

Abstract

One of the most challenging prostheses to fabricate is an acceptable orbital prosthesis. Successful reconstruction of the complex missing tissues, the globe, muscle, skin, and bony elements requires time and high levels of practical skill. A good match to the contralateral nondefect side will help mask the underlying defect and give the patient confidence to return to normal, routine life. The contralateral eye opening will commonly dictate the eye opening of such a prosthesis, but because of the expressive nature of the eye and its high levels of mobility, this can be difficult to achieve. This clinical report presents a patient who had an extended orbital exenteration and right maxillectomy to remove a maxillary squamous cell carcinoma. An alternative approach to constructing an orbital prosthesis was undertaken with the eye closed. Compared to the normal method of fabrication, this process was less complex and quicker, made the prosthesis less “staring,” camouflaged the defect, and reduced the detection of the prosthesis because of movements in the remaining eye. The patient engaged in his routine daily life, which reinforced his self-esteem, confidence, and reintegration into the community.

Section snippets

Clinical Report

A 63-year-old man was referred to the reconstructive clinic at the Maxillofacial Unit of Queens Medical Center in Nottingham, UK, for the fabrication of an orbital prosthesis. After being diagnosed with a right maxillary squamous cell carcinoma, he underwent an extended right orbit exenteration that included part of the right cheek and a partial maxillectomy (Fig. 1A). The patient had received no radiotherapy after his primary surgery, and the site had healed well with no complications. After

Discussion

Eyes are generally the first features of the face to be noticed. A person in need of an ocular prosthesis may have lost or damaged his or her natural eye as a result of trauma, malignancy, or congenital absence.15 Each of these etiologies leaves its own physical characteristics and psychological traits; they can all be seen as traumatic outcomes for the patient. For example, removal after a diagnosis of malignancy brings with it the constant fear of recurrence. Common to them all, however, is

Conclusion

Orbital prostheses are challenging for both the practitioner and patient. Reproducing the expression, character, and personality of the patient present in the contralateral eye is almost impossible. This clinical treatment used an original approach of making a closed eye prosthesis that restored esthetics, simplified manufacture, and provided a compromise that was acceptable to the patient.

References (17)

There are more references available in the full text version of this article.

Cited by (12)

  • Orbital exenteration: an updated review with perspectives

    2021, Survey of Ophthalmology
    Citation Excerpt :

    Prostheses are usually delivered with an opened artificial eye with satisfactory cosmetic outcomes in static position. A closed-eye prosthesis has been described with the following advantages: less complexity, faster delivery, and reduced visibility of the prosthesis when the remaining eye is moving.47 Information on prosthesis aftercare is provided to each patient.

View all citing articles on Scopus
View full text