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Background: Evaluation of the number of enucleations and eviscerations performed in Germany and the orbital implants used., Method: Analysis of the quality reports of German ophthalmological clinics for the years 2012-2021 provided by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA)., Results: Almost 10 times as many enucleations (8368) as eviscerations (975) are performed in Germany. After enucleation, alloplastic implants are used most frequently (44.6% alloplastic, no further specification, 30.0% alloplastic coated, no further specification; 14.1% microporous implants) and autologous dermis-fat grafts in 6.1% of the cases., Conclusion: In Germany, significantly more enucleations than eviscerations are performed. Alloplastic orbital implants are preferred for primary reconstruction following enucleation., (© 2024. The Author(s).)

Copyright of Der MKG-Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der MKG-Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der MKG-Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der MKG-Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der MKG-Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Various surgical techniques are available for the extirpation of an eye, depending on the underlying disease. Typical indications encompass tumors, inflammatory and infectious processes, glaucoma, trauma as well as congenital malformations. Surgical procedures include evisceration (resection of the intraocular space with preservation of the sclera), enucleation (extirpation of the entire eyeball including sclera and cornea) and exenteration (resection of the complete orbital soft tissue). The early detection of postoperatively manifesting complications, such as implant extrusion, conjunctivitis, postenucleation socket syndrome as well as the development of enophthalmus or ptosis, is of particular relevance in the context of postoperative care regarding functional, esthetic and social outcome. Special attention must be paid to ensuring a complication-free rehabilitation process, including the supply of a suitable, precisely fitting prosthesis or epithesis. This ensures the patient's psychosocial reintegration, in which an integrated interdisciplinary cooperation with ocularists and psychologists is essential. The latter play a particularly important role, as the psychological stress resulting from the procedure is often associated with a considerable reduction in the quality of life., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Copyright of Der MKG-Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Coralline hydroxyapatite has been used since 1983 as volume replacement. Through 2001, a total of 200 hydroxyapatite implants were used in our department., Objective: This prospective study was undertaken to measure the subjective and objective long-term tolerance of this implant., Materials and Methods: In 2012, a total of 20 patients were examined, who were enucleated or eviscerated between 1993 and 2001 (average follow-up 16.2 years) and had an hydroxyapatite implant placed with a scleral sheath. We evaluated the subjective tolerance and measured the motility, the prominence of the globe, lid positions, changes of the conjunctiva and postoperative complications., Results: The subjective long-term tolerance was reported to be good. All patients had a ptosis; an ectropion was found in 50% of patients. In 40% of the patients additional surgery was performed. The motility was better in primary than in secondary placed implants. Volume replacement was successful in 10 patients, 9 patients had a retraction and 1 patient a prominent prosthesis., Discussion: Hydroxyapatite implants with sclera sheathing were well tolerated and showed good motility on long-term follow-up over more than 16 years. Lid malpositions such as ptosis or ectropion are common but might be due to mechanical stress through the prosthesis and atrophy of the orbital fat.

A 67-year old patient presented with persistent wound dehiscence after evisceration. The scleral shell and the implant were removed. The histopathological and immunohistochemical examination of the tumor revealed epithelial ingrowth and infection of the implant. Even if the intervention is known since the 16 th century, technics and materials are still undergoing improvements and discussions. Incarceration or tension on the suture should be avoided in order to prevent secondary complications.

Dermofat grafts represent an alternative to alloplastic orbital implants and are used as primary or secondary implants. Advantages are their autologous nature without the risk of foreign body reaction and extrusion or possibly transmission of prions in combination with creating a flat and smooth surface in the socket even under difficult conditions with an excellent motility of the artificial eye. Disadvantages of dermofat grafts are the labor-intensive operative technique with a second operation site and a possible shrinking of the implant. The operation technique is presented in detail in an operation video, which is available online.

Since the introduction of the first coralline hydroxyapatite porous orbital implant as eye replacement in the early 1980s, numerous other modified porous implants have been developed. Due to the different design of the existing studies concerning long-term safety with, in some cases, relatively short follow-up, a comparison is difficult and none of the implant types can be clearly identified as being superior. Factors affecting the exposure rate of the implant seem to be the implant coating, the surgical technique and the condition of the patient's tissue at the beginning of surgery.

Children suffering from congenital anophthalmos (absence of eyes) or blind microphthalmos (eyes too small without light perception) show significant smaller eyelids, conjunctival sacs and orbital volume due to the lack of intrauterine growth stimulus. Highly hydrophilic osmotic expanders allow prostheses to be fitted in the first year of life to compensate for the volume deficit and the substantial aesthetic disadvantages and to stimulate lid development.

Precise anatomical reconstruction of extensive orbital fractures is a challenging procedure for surgeons. Computer-assisted technologies, anatomical preformed implants and the possibility of acquiring 3D images using cone beam computed tomography are considered as the new standards. In this short review these applications are presented.

Background: Since Tjellstrom introduced in 1977 percutaneous osseointegration, the importance of osseointegrated implants has increased in the head and neck region. Implants and craniofacial surgery technology have been permanently improved and the use of extraoral osseointegration has expanded considerably. The surgical reconstruction of the exenterated orbit provides often only poor aesthetic results. Therefore the rehabilitation of complex midfacial structures is an indication for osseointegrated retained facial prostheses., Methods and Material: The international literature has been reviewed concerning the topic of osseointegration for the retention of orbital and midfacial prostheses. A new plate-like implant system is introduced. We report about our experiences with the "Ti-Epiplating System"., Discussion: The "Ti-Epiplating System" is available since 2001. For every location in the head and neck there exists a specially shaped plate. The "Ti-Epiplating System" is fixed subperiostally with normal bone screws, the same as used in traumatology. In cases of extended resections with less bone substance left, the application is simplified. The osseointegration time is reduced to a minimum of 6 weeks. Postoperative radiation is possible., Conclusion: The improved application of the "Ti-Epiplating System" is beneficial in the reconstruction of extended craniofacial defects with osseointegrated implants.

Orbital traumas and tumour operations may cause defects the operative management of which sets high requirements on the surgeon. For covering defects, transplants or implants are available. There is a risk of inflammation due to the free contact of the implants to the cavity of the inner nose or the sinus. Today, implants made from titanium, porous polyethylene, PDS (poly-p-dioxanon) foils, and ceramic materials are preferred. Alternatively, autogenous transplants can be used. These are immunologically harmless but they are of only limited availability. Moreover, a second operation for taking the transplants with creation of a donor defect is necessary.

In earlier experiments healing of large orbital wall defects in sheep occurred undisturbed by osteoconductive bone growth along biodegradable membranes when there was no interference with additional bone grafts or titanium miniplate osteosynthesis. In this experiment similar bilateral defects were reconstructed with poly(L/DL 80/20) lactide implants using a microporous membrane 0.5 mm thick without further support on one side, an 0.25 mm microporous membrane supported by solid polylactide buttresses and stabilized by polylactide dowels on the opposite side. After 12 months we found a symmetrical reconstruction of the normal anatomy of the orbits in CT and X-ray examinations. In contrast, histologic investigations revealed massive foreign-body reactions around degrading buttress implants and dowels especially. Milder reactions occurred in some orbits along the membranes as well, in contrast to our earlier experiments with 4-month follow-up. None of the implants had degraded completely 12 months after surgery. In our 12-month long-term survey, polylactide microporous membranes confirmed their osteoconductive potential in orbital wall reconstruction. Nevertheless, massive polylactic implants should not be considered for clinical application in the orbit because of significant late foreign-body reactions.

Background: We surveyed ocularists' views on orbital implants, secondary surgical procedures, patient satisfaction, and cooperation between ophthalmologists and ocularists., Method: A 14-item questionnaire was sent to all 29 ocularists working in Germany all 4 in the Netherlands., Results: Primary implants are generally recommended, preferably dermofat grafts and ,,baseball" implants. Outcome depends crucially upon surgical procedure and postoperative course. Scepticism is common toward secondary surgical procedures, with the success rate estimated at 70%. Cooperation between ocularists and ophthalmologists is generally regarded as unsatisfactory, also the information provided to the patients by the ophthalmologist after enucleation., Conclusions: The ocularists demand best possible enucleation techniques including the use of primary implants. However, they are critical toward secondary procedures for correcting postenucleation socket syndrome. Cooperation between ocularists and ophthalmologists need to be improved in providing patient care.

Background: The aesthetic result of a prosthetic reconstruction in the facial area depends on precise, long-term stable positioning of the facial prosthesis. For fixation of the facial prosthesis and contouring of the soft tissue, good long-term success can be achieved by implant-magnet systems. The precise positioning of the implants and magnets when only little bone is available is difficult and without any planning is often not possible., Computer Evaluation: Computer-supported evaluation of CT data with the aid of CT and drill templates can optimise the planning and carrying out of surgery. This procedure is illustrated with reference to the treatment of a patient following obital exenteration due to an embryonic rhabdomyosarcoma. The programs SIM/Plant and coDiagnostiX were compared with one another when carrying out the CT evaluation and planning the orbital prosthesis. In so doing, the great advantage of the definition of the CT window (grey levels), the freely definable panorama sections and cross-sections, as well as the three-dimensional, spatial representation using the programme coDiagnostiX on a conventional PC are made clear. The results of planning can be applied and implemented during surgery, with the aid of the CT and drill templates., Discussion: The CT computer template-supported procedure is suitable for routine clinical use and can be recommended for planning of implant-fixed facial prosthesis in the orbital area when little bone is available or in the case of difficult anatomical relationships.

Background: Congenital anophthalmos is a rare condition in which intervention in an early age can stimulate orbital expansion. The therapeutic goal was to allow retention of a suitable prosthesis and to maximise facial symmetry., Methods and Patients: We report on 3 anophthalmic newborn male patients, of which one presented with microphthalmos in the other eye as well as associated systemic disorders. Solid moulded shapes were adapted and manufactured out of methylmethacrylate to increase expansion of orbital soft tissue and bone. The moulding of the orbita was performed by silicone made of two components under general anaesthesia during the first two years of life. The following day the solid shapes were fitted in the outpatient department. They were increased in size when they started to rotate within the orbit or when the eyelids were relatively loose around the solid shape. The initial insertion of the orbital expander was performed in the first weeks after birth and was repeated every 3 to 6 weeks within the first year of life. The degree of orbital expansion was determined by measurements of the horizontal eyelid length, the volume of the solid shapes, by measuring the volume in cm3 of water displaced by the shape after submerging it in a cylinder of water and assessment of the cosmetic aspect., Results: Within 8 months of therapy a horizontal eyelid lengthening to 10 mm and an increase of the volume of the orbital expander from 1.5 cm3 to 6 cm3 was achieved in patient 1. After 20 months of therapy patient 2 showed symmetry of the face and the horizontal eyelid length. In patient 3 therapy started 3 years late and after 2 years only a horizontal eyelid lengthening of 3 mm and a suboptimal symmetry of the face was achieved., Conclusion: Our own experience suggests that early prosthetic fittings are necessary for an ideal cosmetic outcome. Motivation and cooperation of the parents is an important factor to achieve optimal results.

Background: Since its first implantation as an eyeball replacement in the United States in 1985, hydroxyapatite has been rarely used as an orbital implant in Germany. The aim of the study was to collect data on long-term tolerance, postoperative complications and the cosmetic end results., Patients and Methods: In the spring of 1997, 52 patients underwent a follow-up examination at our hospital. The average post-operative follow-up period was 23 (12-41) months., Results: The subjective tolerance was considered good by 3/4 of the patients. In the comparison of position and prominence of the artificial eye, 8 patients achieved complete equalization. As regards defective lid position, 8 patients had a ptosis, 6 an ectropium, and there was one case of entropium. Changes in conjunctiva stretched from muciferous secretion to follicular squamous hyperplasia. There was no case of implant extrusion in the series examined. With reference to the method of implantation, far superior motility was observed in primary implantations. Statistically significant motility differences could not be shown regarding muscle attachment because of the small number of the cases., Conclusions: In the series examined, hydroxyapatite proved to be a generally well-tolerated orbital implant with few postoperative complications and good motility. Primary implantation with attachment of all six eye muscles gave the best results.

From the aesthetic point of view, a patient can be completely rehabilitated after the loss of an eye with the insertion of an artificial eye made of glass. If the delicate structures of the eyelids have been severely damaged, however, or if the eye socket does not provide adequate retention for an eye prosthesis, rehabilitation becomes more difficult, and sometimes cannot be achieved with a cosmetically satisfactory result. In such cases, a facial prosthesis offers an alternative solution. Stable retention can be ensured with craniofacial implants. Single-sided rehabilitation by this method is quite common, but bilateral treatment is a rarity. We report on the prosthetic rehabilitation of a patient after exenteration on both sides due to retinoblastomas.

Endosteal implants after tumor surgery of the face are helpful in reconstructing facial defects. A retrospective study of our patients treated using craniofacial implants was conducted to evaluate long-term results. A total of 128 implants were inserted, 110 implants in the periorbital, 12 implants in the mastoid, and six implants in the paranasal region; 113 implants were short craniofacial Brånemark implants, and 15 implants were dental implants. The success rate for implant survival was 94.5%. Long-term results were promising and more than satisfactory, leading to a large indication for these endosteal implants.