Figure 1.
Surgical procedures of orbital implant exposure management on porous implants.
(A) Carefully dissect along the subtenon and orbital implant and check the extension of exposure area; (B) Suture the four isolated extraocular rectus muscles onto the wrapped implant; (C) Harvest oral mucosa after sizing the conjunctival defect and suture the harvest oral mucosa to the surrounding conjunctiva of the ocular surface; (D) The sagittal view of the orbit illustrates the relative positions of the implant, the wrapping material, extraocular muscles, and the oral mucosa.
Figure 2.
Surgical procedures of orbital implant exposure management on non-porous implants.
(1) Document the appearance of the exposed implant; (2) Carefully dissect between the tenon and the orbital implant; (3) Enucleate the wrapped implant (front); (4) Inspect for irregularity or infection and invert the implant; (5) Isolate six extraocular muscles; (6) Insert the wrapped implant with the exposure surface facing toward the orbital apex; (7) Suture the rectus muscles onto the wrapped implant; (8) Reinforce with oblique muscles to augment coverage; (9) Harvest oral mucosa after sizing the conjunctival defect; (10) Suture the harvest oral mucosa to the surrounding conjunctiva of the ocular surface; (11) Insert conformer to maintain fornices for future prosthesis fitting; (12) Inspect the wound regularly (post-operative 10 days).
Table 1.
Demographics of patients.
Figure 3.
Algorithm for managing the implant exposure.
Different approaches are applied on different implant types. For porous implants, exposure smaller than three millimeters is treated conservatively. Larger exposure is surgically managed according to the respective mechanism. For non-porous implants, exchange the implants to porous ones. Good vascularization is universally provided. Oral mucosa is transplanted when the remaining conjunctiva is incapable of supporting fornices adequately.