Orbital Prosthesis: Comprehensive Overview
Definition and Indications
An orbital prosthesis is the preferred non-surgical alternative for cosmetic and psychological rehabilitation following orbital exenteration when reconstructive surgery is not feasible or desired by the patient. 1, 2
Orbital exenteration is performed to treat:
- Orbital neoplasms (primary or metastatic tumors) 1
- Maxillary squamous cell carcinoma with orbital extension 3
- Severe orbital trauma requiring complete removal of orbital contents 2
- Non-malignant diseases necessitating orbital content removal 1
Multidisciplinary Surgical Planning
The ophthalmic surgeon and maxillofacial prosthodontist must work as a coordinated team from the initial surgical planning stage to achieve optimal prosthetic outcomes. 1, 4
Key surgical considerations that facilitate later prosthetic success:
- Preserve adequate bony orbital rim to support prosthetic retention 4
- Maintain smooth, well-healed soft tissue margins without excessive scarring 4
- Consider osseointegrated implant placement at the time of exenteration for future prosthetic anchorage 4
- Document defect dimensions and anatomical landmarks for prosthodontic reference 4
Essential Prosthetic Characteristics
A successful orbital prosthesis must possess five critical qualities:
- Aesthetic appearance matching the contralateral side 2
- Durability to withstand daily wear and environmental factors 2
- Lightweight construction to prevent tissue strain and discomfort 2
- Economic feasibility for patient accessibility 2
- Secure retention to prevent embarrassing displacement 2
Prosthetic Design Approaches
Open-Eye Design (Traditional)
- Mimics the contralateral eye opening for symmetry 3
- More complex fabrication requiring precise iris positioning and scleral matching 3
- Higher risk of appearing "staring" due to lack of natural eye mobility 3
- More easily detected when the remaining eye moves 3
Closed-Eye Design (Alternative)
The closed-eye orbital prosthesis offers significant advantages over traditional open-eye designs, particularly for patients concerned about prosthesis detection. 3
Benefits include:
- Less complex and quicker fabrication process 3
- Reduced "staring" appearance that can unsettle observers 3
- Better camouflage of the defect through natural eyelid positioning 3
- Decreased detection because movements in the remaining eye don't highlight prosthetic immobility 3
- Enhanced patient confidence and community reintegration 3
Retention Methods
Anatomical Retention
- Undercuts in the orbital rim provide mechanical retention 1
- Tissue adhesives for temporary daily wear 1
- Spectacle frame integration for additional support 1
Implant-Supported Retention
Osseointegrated implants provide the most secure and accurate aesthetic reconstruction for orbital defects. 4
- Requires careful surgical planning between oral/maxillofacial surgeon and prosthodontist 4
- Magnetic attachments can connect prosthetic components in confluent maxillary-orbital defects 5
- Demands patient commitment to multiple treatment phases 4
Aesthetic Enhancement Techniques
Incorporating the patient's own hair for eyelashes dramatically improves prosthetic aesthetics and patient acceptance. 2
Additional refinements:
- Custom iris painting to match the contralateral eye 1
- Silicone intrinsic coloration for natural skin tone matching 1, 2
- Surface texturing to replicate skin characteristics 1
- Eyebrow reconstruction using patient's hair or synthetic materials 2
Special Considerations for Confluent Defects
For patients with combined maxillectomy and orbital exenteration, a three-component prosthetic system optimizes both function and aesthetics. 5
The system includes:
- Maxillary obturator to restore deglutition and mastication 5
- Orbital conformer to seal medial, septal, and posterior walls preventing air escape during phonation 5
- Orbital prosthesis for external aesthetic restoration 5
- Rigid magnetic attachments connecting all components 5
This approach addresses the critical problem where unobturated orbital defects allow air escape, severely compromising speech quality 5.
Functional and Psychological Outcomes
Successful orbital prosthetic rehabilitation significantly improves quality of life by restoring self-esteem, confidence, and enabling community reintegration. 1, 3
Functional benefits:
- Cosmetic restoration reducing social stigma 1, 2
- Psychological rehabilitation addressing body image concerns 1, 2
- Speech improvement when combined with proper obturation in confluent defects 5
- Protection of the defect from environmental exposure 4
Common Pitfalls and Solutions
The most challenging aspect of orbital prosthesis fabrication is achieving acceptable reconstruction of complex missing tissues including globe, muscle, skin, and bony elements. 3
Critical success factors:
- Adequate healing time (typically 3-6 months post-surgery) before prosthetic fabrication 4
- Multiple fitting appointments to refine contours and color matching 1
- Patient education on insertion, removal, and maintenance 4
- Regular follow-up to assess tissue changes and prosthetic integrity 4
- Realistic expectations regarding prosthetic limitations compared to natural anatomy 3