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The aim of the study was to compare automated and manually conducted (slice-by-slice) virtual orbital wall reconstruction in terms of PSI design, manufacture, and clinical application for orbital fracture management. Patients with orbital wall fractures were evaluated for the potential for treatment with PSI, based on automated virtual wall reconstruction; these formed the main group. The surgical outcomes of these main-group patients' treatments were compared with those of the control group, which comprised patients randomly selected for this study, each of whom had the same orbital trauma patterns and were also managed with PSI. However, the control group patients were treated using 'slice-by-slice' virtual orbital reconstruction. Mean volume differences between the intact and reconstructed orbit were 0.65 ± 0.26 cm

The use of patient-specific implants for reconstruction of complex orbital floor defects is increasing and requires communication with an industry partner, which warrants investigation. Therefore, the aim of this study was to evaluate the effects of in-house training of engineers on such communication as well as to identify frequent sources of problems and their solutions for improvement of the implant-planning workflow.We conducted a retrospective cross-sectional study and enrolled a sample of patients who had undergone orbital reconstruction with patient-specific implants between 2017 and 2020. The predictor variables were in-house training (additional training completed in hospital or not) and implant complexity (complex [multiwalled implants] vs less complex [isolated orbital floor reconstructions]). The outcome variables were duration of communication, message length, and need for synchronous communication or modifications to the original design. Descriptive, univariate, and multivariate statistics were computed, and statistical significance was set at a P value of0.05.This study included the data of 66 patients (48 men and 18 women, average age: 42.27 years). The complexity of the implant statistically significantly increased the duration of the communication (8.76 vs 16.03 days; P = .004). In 72.73%, the initial design had to be changed. Engineers trained in house required less communication to plan less-complex implants and generally needed fewer corrections to the original design (P = .020 and P = .036, respectively). Problems during planning were observed in 25.76% of the cases, with an insufficient diagnostic 3-dimensional data set being the most common (15.15%).In-house training of engineers is time-saving while planning the workflow for patient-specific implants, especially in less-complex cases, given that design changes are not needed often. The high rate of data sets that were insufficient for planning patient-specific implants suggests that diagnostic 3-dimensional data sets should already meet the requirements for such planning.

Patient-specific titanium implants are increasingly used in orbital trauma as a means of achieving improved surgical outcomes as well as decreasing postoperative complications; however, the data to support their use remain limited. The purpose of this study is to compare the complication rates and accuracy of orbital reconstruction using preformed titanium mesh implants and patient-specific implants.The authors conducted a retrospective cohort study consisting of patients with orbital floor and/or medial wall fractures treated by reconstruction with either preformed or patient-specific implants from August 1, 2015 to December 31, 2020. The primary predictor variable was the implant type. Outcome variables were the percent volume difference between the reconstructed and uninjured orbital volume and complications. Statistical analysis was performed using Fisher exact test and Wilcoxon rank-sum test.Of the 85 patients in the study, 73% were male and the average age was 38.7 ± 16.6 years. Sixty-one patients (72%) were treated with preformed implants and 24 (28%) with patient-specific implants. Complications occurred in 8.3% of the patient-specific implant group and 26.2% of the preformed implant group (P = .08). Percent volume difference between the reconstructed and nontraumatized orbit was 4.2% and 6.8% in the patient-specific and preformed implant group, respectively (P = .03).Patient-specific implants improved orbital volume reconstruction accuracy but did not decrease complications when compared to preformed implants.

Statement of problem Implant-supported and implant-retained extraoral prostheses are reliable treatment options for patients with craniofacial defects. They provide stable retention and therefore enhance the patient's appearance and quality of life. Despite studies on survival rates of extraoral implants, little attention has been paid to the design of the implants used to support and retain extraoral prostheses. Purpose The purpose of this longitudinal clinical study was to assess the long-term survival rate (1 to 12 years, mean 6 years) of 2 different designs of implants (disk: single, double, and triple and screw-type) used for extraoral epithesis anchorage. Material and methods Twenty-six participants with orbital and nasal defects, 10 of whom had had radiation treatment, were included in the study. Disk implants and extraoral (EO) screw implants were used and placed in the periorbital (15 participants) and perinasal regions (11 participants). Data were analyzed by using the Chi-square test and the Fisher Exact test for qualitative variables and the Mann-Whitney U test for comparison of quantitative variables. Implant survival rates were calculated by Kaplan-Meier analysis. Results The overall 12-year survival rate of all implants was 90.3% (mean=79 months), with 92.9% for nasal (mean=84 months) and 88.2% for orbital (mean=75 months) implants. Related to the implant design, survival rates were as follows: for single-disk implants, 90.2%; for double disks, 94.6%; for triple disks, 88.3%; and for screw implants, 83.3%. In nonradiated participants, the implant survival rate was 97.6%, and for radiated participants, 76.1%. Conclusions Survival rates for implant-retained craniofacial prostheses are limited. The nasal site seems to be a more predictable implant site than the orbital site, with a higher overall survival rate. Also, implants inserted in radiated tissues have lower survival rates for both anatomic sites, with statistically significantly lower results in the orbital region. The most reliable type of implant among the disk implants used was the double disk in the orbital site and the single disk in the nasal site, which may indicate the advantages of some designs in specific areas.

The aim of this retrospective monocentric study was to report the outcomes following the correction of post enucleation socket syndrome (PESS) as well as the factors predicting for a multistep management. Patients were included, if they had received surgery to manage PESS. Demographics and patient history were collected. The symptoms of PESS were clinically rated by the same surgeon and ocularist, preoperatively and after each procedure. The surgery was considered as successful when no PESS clinical symptoms were observed. A prognostic study was performed to investigate the surgical outcomes. RESULTS: Thirty-six patients were included and eight of them had their PESS corrected after the first surgery. In the multivariate analysis (MVA), the deep upper lid sulcus symptom remained the main significant factor associated with an incomplete correction after the first surgery (OR 45.5, IC 95% (3.481-594.6), p = 0.004). For further corrections, the ptosis was the only significant prognostic factor requiring several surgeries (p = 0.005). At the end of the management, 94.4% of the patients had satisfying outcomes. CONCLUSIONS: The management of a PESS involves the correction of both the orbital cavity and the soft tissues. Although its correction is complex and time consuming in the majority of cases, the patients should be informed that the final cosmetic outcomes remain good at the expense of several surgeries.

Deep and complete reconstruction of the orbital cavity has been shown to be essential for preventing enophthalmos and hypoglobus in patients with orbital defects or deformities. Additively manufactured patient-specific titanium implants provide unlimited options in design. However, implant malpositioning can still occur, even when intraoperative imaging and navigation are used. In this study, we investigated novel orbital implants containing features facilitating self-centering. Accuracy of implant placement and reconstruction of the orbital dimensions were compared retrospectively between self-centering second-generation patient-specific functionalized orbital implants (study group) and CAD-based individualized implants (control group). Design features of implants in the study group included functionalization with navigation tracks, a preventive design, and flanges - so called stabilizers - towards opposite orbital walls. Implant position was evaluated by fusion of preoperative virtual plans and the post-therapeutic imaging. Aberrances were quantified by 3D heatmap analysis. 31 patients were assigned to the study group and 50 to the control group, respectively. In the study group, most implants were designed with either one (n = 18, 58.06%) or two (n = 10, 32.26%) stabilizers. Twice (6.45%), one stabilizer had to be shortened intraoperatively. Implant fit analysis revealed a significantly more precise (p 0.001) positioning in the study group (n = 22/31) than in the control group (n = 42/50). Self-centering second-generation patient-specific functionalized orbital implants showed significantly more accurate implant positioning, facilitating the transformation of virtual plans into patient's anatomy. The presented design provides an additional instrument for intraoperative quality control besides intraoperative imaging and navigation.

The aim of the study was to assess factors leading to revision surgery and implant position of primary orbital fracture reconstructions. A retrospective cohort included patients who underwent orbital floor and/or medial wall fracture reconstruction for recent trauma. Demographics, fracture type, surgery and implant-related variables, and postoperative implant position were analyzed. The overall revision surgery rate was 6.5% (15 of 232 surgeries). The rate was highest in combined midfacial fractures with rim involvement (14.0%), lower in zygomatico-orbital fractures (8.7%), and lowest in isolated blowout fractures (3.8%). Fracture type, orbital rim fixation and implant malposition predicted revision. The best positioning was achieved with patient-specific milled titanium implants (mtPSI) and resorbable materials, whereas the poorest with preformed three-dimensional titanium plates. Combined midfacial fractures with rim involvement in particular have a high risk for orbital revision surgery. Within the limitations of the present study, mtPSIs should be preferred in the reconstruction of primary orbital fractures if possible. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Association for Cranio-Maxillo-Facial Surgery.

Purpose A proof-of-concept workflow study for the fabrication of custom orbital exenteration prostheses via automated noncontact scanning, 3D printing, and silicone casting. Design Noncomparative, interventional case series. Methods S etting : Single-center institutional study. S tudy P opulation : Three patients who have discontinued wearing of the ocularist-made exenteration prosthesis due to altered fit, discoloration, or material degradation. I ntervention P rocedure : A digital representation of the exenteration socket and contralateral periocular region was captured through noncontact facial topography mapping. Digital construction of the anterior prosthesis surface was based on the mirrored image of the contralateral side, and the posterior surface contour was based on orbital cavity geometry. The anterior and posterior surface details were digitally merged. A 2-piece mold was designed and produced in a 3D printer. Colorimetry was used to create a custom blend of pigments for incorporation into the Shore 40 silicone elastomer to generate a prosthesis that approximates the patient's skin tone. M ain O utcome M easures : Prosthesis symmetry, skin tone match, comfort of wear, and appearance. Results The first copy of every 3D-printed orbital prosthesis using this fabrication workflow produced good symmetry, color match, and prosthesis fit. In one case, the recontoured second copy with improved prosthesis edge-to-skin interface was made without the patient present. Conclusion A noncontact 3D scanning, computer-aided design, 3D printing, and silicone casting for fabrication of orbital prosthesis was developed and validated. This production workflow has the potential to provide an efficient, standardized, reproducible exenteration prosthesis and to overcome the principal barriers to an affordable custom prosthesis worldwide: access and cost.

Rationale and Objectives Surgical repair of an isolated orbital fracture requires anatomically accurate implant shape and placement. We describe a three-dimensional (3D) printing technique to customize the shape of commercially available absorbable implants. Materials and Methods We reviewed our early experience with three cases in which 3D printed molds were utilized for fracture repair. The institution's medical records were reviewed to assess operative time for orbital floor blow-out fracture repairs. Thin section computed tomography (CT) images were loaded into a clinical 3D visualization software, and stereolithography models were created. The models were loaded into stereolithography editing software in which the nonfractured side was mirrored and overlaid with the fractured side. Sterilizable 3D printed molds were created using the fracture images as well as the virtual mirrored images. The molds were taken to the operating room and used to shape a customized orbital implant for fracture repair, using off-the-shelf bioabsorbable implants. Results The three patients treated using 3D printed molds had excellent outcomes, with decreased postoperative edema and rapid resolution of ocular misalignment/strabismus. Surgical times were decreased from an average of 93.3 minutes using standard implants to 48.3 minutes following adoption of 3D printed molds. Conclusion Three-dimensional printed models can be used to create molds for shaping bioabsorbable implants for customized surgical repair, improving fit, reducing tissue handling and postoperative edema, and reducing surgical times.

Three cases are presented of anophthalmic patients with exposed orbital implants. Although only one patient showed evident clinical signs of infection, all three implants were studied to determine the presence of microorganisms adhered to their surface using a scanning electron microscopy (SEM) and microbiological culture. The SEM allowed the visualisation of microorganisms adhered to the three implants, although only one of them showed growth in the microbiological cultures. In addition, the SEM technique used in case No. 3 achieved a better orientation and appreciation of the microorganisms with respect to the images of cases No. 1 and 2. These findings support the idea that the surface of exposed orbital implants is colonised by microorganisms, even when they still do not show obvious signs of infection. Therefore, mechanical removal of the exposed surface of the implant is necessary before covering it with grafts or flaps.

The satisfactory management of post-enucleation socket syndrome is a major challenge. In addition to enophthalmos and hypophthalmos, the appearance of the supratarsal fold is frequently unsatisfactory. Using a combination of orbital volume reduction by means of custom wave-shaped CAD/CAM implants (1), the implantation of a dermis-fat graft (2), and the fitting of an acrylic eye prothesis (3), an algorithm has been developed that has led to considerable long-term improvements. 10 patients have already been treated by this method. The most important step is the reduction of orbital volume by means of custom wave-shaped CAD/CAM implants. These move the intraorbital soft tissue in an anterior and cranial direction. This considerably reduces the required volume of additional dermis-fat grafts, which are always subject to resorption. The use of an acrylic eye prothesis facilitates the aesthetic and functional correction of this condition and exerts less pressure on the lower eyelid due to its low weight. The method presented here leads to stable and aesthetically pleasing results with a minimum risk of complications. One problem is the exact predictability of the necessary orbital volume reduction by the custom wave-shaped CAD/CAM implants. Further studies and a larger number of cases are required to address this problem.

A permanent orbital implant is highly required to support ocular tissues after surgical removal of patient’s eye during an ocular disease treatment. We therefore study the feasibility to use egg shell waste for producing biomedical porous glass–ceramic orbital implants. A biocompatible porous glass–ceramic implants were prepared from egg shell-based calcium-silicate glasses by foam replication method. The egg shell-derived glass–ceramic implants obtained a pure biocompatible CaSiO3 phase at 1100 °C. In comparison to the glass–ceramic implants from a commercial CaCO3, the egg shell-derived glass–ceramic implants contained an open-macropore network with porosity over 30% allowing the fibrovascular tissue ingrowth. The glass–ceramic implants derived from egg shells had good chemical stability in simulated body fluids (2-weeks in vitro test). Therefore, this new porous glass–ceramic material is a promising alternative low-cost biomedical implant for ocular prosthesis applications.

For a patient with a unilateral orbital defect, an esthetic orbital prosthesis plays an essential role in enhancing quality of life. This technique describes the combined use of a facial scanner and an intraoral scanner to acquire the digital scan for the design and fabrication of an orbital prosthesis. The method results in an esthetic prosthesis with accurate skin texture reproduction.

Purpose The objective of this study was to present the surgical and clinical outcomes of polyester urethane implants in orbital trapdoor fracture repair in children. This is the first study reporting on the use of polyester urethane implants to repair orbital fractures. Materials and Methods A retrospective review was performed of children with orbital trapdoor fracture who underwent surgical repair in the authors' medical center over 6 years. The trapdoor fracture diagnosis was based on clinical and computed topographic findings. Results Eight patients with trapdoor fracture were identified. All cases were repaired by polyester urethane implant placement. Patients' mean age was 13.5 years and mean follow-up was 13.6 months. All patients had orbital floor fractures. Two fractures also involved the medial wall. Seven patients had inferior rectus muscle entrapment and 1 had medial rectus muscle entrapment. Three patients had residual diplopia on extreme upgaze after the surgical repair. No patient had enophthalmos or infraorbital paresthesia at the end of follow-up. No postoperative complications associated with the used material were reported. Conclusion The polyester urethane implant is a reliable, safe, inexpensive, and effective implant for trapdoor fracture repair in children. It can serve as a promising alternative to implants fabricated from other synthetic materials for orbital floor fracture repair.

Purpose To investigate the clinical features and risk factors of atypical mycobacterial infection in anophthalmic sockets with porous orbital implant exposure. Design Case-control study. Methods The medical records of all patients who had undergone surgical correction of porous orbital implant exposure were consecutively reviewed, and the patients were stratified as those with atypical mycobacterial infection (AM infection group) and others (non-AM group). Results Five and 21 patients were included in the AM infection and non-AM groups, respectively. All patients of the AM infection group had a peg or motility coupling post (MCP) and showed implant exposure around it. Following up on implant exposure, 2 patients abruptly presented with severe conjunctival injection and new lesions such as erythematous nodules or eyelid masses. They underwent immediate orbital implant exchange and atypical mycobacterial infection was diagnosed. Three patients who were not suspected of having infection underwent surgery for orbital implant exposure. Results revealed erythematous eyelid nodule or recurrent exposure shortly after surgery and patients were diagnosed with atypical mycobacterial infection. In the non-AM group, 7 (33.3%) patients underwent insertion of a peg or MCP. Statistical analysis showed that the insertion of a peg or MCP was the only risk factor showing a significant difference between the 2 groups. Conclusions The most important underlying risk factor for atypical mycobacterial infection in the anophthalmic socket is thought to be peg- or MCP-related exposure of the porous orbital implant. Surgical removal of the infected orbital implant and long-term antibiotic medication are needed for treatment.

Purpose The purpose of this study was to evaluate the orbital patient-specific implant (PSI) directly printed in porous titanium for the reconstruction of complex orbital bone defects in a series of 12 patients. Patients and Methods The authors designed and implemented a case series. The sample consisted of patients with unilateral complex orbital bone loss. All patients received a porous titanium PSI designed from the healthy contralateral side (mirroring). The criteria analyzed were the functional results: correction of enophthalmos, correction of ocular motility, operative time, complications, and operative revisions. The study was performed from 2015 through 2017. Results The sample was composed of 12 patients (mean age, 47 yr; age range, 13 to 70 yr). Patients were followed for a mean of 36 weeks postoperatively (range, 4 to 100 weeks). Twelve of the 12 patients presented preoperative enophthalmia, and 8 of the 12 patients presented preoperative diplopia. The mean operating time was 71 minutes (range, 60 to 200 minutes). For 8 patients, the follow-up was simple. In contrast, 2 patients required surgical revision with repositioning of the implant because of intraoperative implant malpositioning with esthetic or functional disturbance and malpositioning was confirmed on the postoperative computed tomogram, 1 patient required explantation of his implant 7 months after the surgery because of spheno-orbital meningioma recurrence (the implant was well positioned), and 1 patient operated on by a subciliary approach presented a postoperative ectropion. In this series of porous titanium orbital PSIs without positioning guides, 17% had malpositioning (2 patients who required a new intervention for repositioning). Conclusion The results of this study suggest that porous titanium PSI could be a surgical option for patients with complex orbital bone defects. In this series 17% of the sample needed a second operation. There are several ways to improve these results, such as intraoperative navigation or integrated positioning guides.

This study developed an anatomical thin titanium mesh (ATTM) plate for Asian orbital floor fracture based on the medical image database. The computer aided stamping analysis was performed on four hole/slot patterns included the control type without hole design, circular hole pattern, slot pattern and hole/slot hybrid patterns within the ATTM plate with upper/lower dies of averaged orbital cavity reconstruction models. The curved-fan ATTM plate with 0.4 mm thickness was manufactured and pre-bent using a patient matched stamping process to verify its feasibility and the interfacial fitness between the plate and bone on the orbital floor fracture model. The stamping analysis found that the hole/slot hybrid patterns design resulted in the most favorable performance among all designs owing to the lowest maximum von-Mises stress/strain and spring-back value. The interfacial adaption results test showed that the average patient-matched stamping bending gap size was only 0.821 mm and the operative time was about 8 s. This study concluded that the curved-fan ATTM plate with hole/slot hybrid pattern design and patient-matched pre-bent technique can fit the ATTM plate/orbital cavity interface well, decrease unstable fracture segment mobility and improve the overall reduction efficiency.

Fractures of the orbital floor and medial orbital wall (blowout fractures) are common midface injuries. Diagnostic methods and treatment options have improved over recent years, due to threedimensional image processing and the use of patient-specific implants. Nonetheless, the indications for orbital reconstructive surgery are still controversial. Previous authors have reported a linear correlation between post-traumatic increases in orbital volume and enophthalmos and diplopia. Post-traumatic increases in orbital volume are often considered to be predictive of long-term symptoms; therefore, it is commonly recommended that orbital volume increases be treated as an indication for early reconstructive surgery. However, the results of this study did not show any statistically significant long-term linear correlation between increased orbital volume and enophthalmos or diplopia, and the performance of orbital volume as a predictor of ocular symptoms was poor. Hence, we do not consider increased post-traumatic orbital volume to be particularly useful for predicting late enophthalmos or diplopia. However, a statistical correlation between fractures of the anterior and medial thirds of the orbital floor and double vision was found. As such, fractures of the middle and anterior third should be regarded as problematic, and surgical reconstruction should be considered in these cases.

Intraoperative navigation is frequently used to assess the position of the implant in orbital reconstruction. Interpretation of the feedback from the navigation system to a three-dimensional position of the implant needs to be done by the surgeon, and feedback is only gathered after the implant has been positioned. An implant-oriented navigation approach is proposed, with real-time intuitive feedback during insertion. A technical framework was set up for implant-oriented navigation, with requirements for planning, implant tracking, and feedback. A dedicated navigation instrument was designed and a software tool was developed in order to meet the technical requirements. An accuracy study was performed to investigate the accuracy of the method in comparison to the regular navigation pointer. A proof of concept was provided. The results showed a translation error of 1.12–1.15 mm for implant-oriented navigation with regular registration (pointer 0.71–0.98 mm) and 0.81 mm with accurate registration (pointer 0.54 mm). Rotational error was found to be small (

Purpose To compare the motility and complication rates of porous and nonporous implants after enucleation surgery. Methods Literature searches of the PubMed and Cochrane Library databases were last performed in February 2017 to identify studies published between 2003 and 2017 on outcomes after enucleation surgeries in which a variety implants were used. The searches were limited to the English language with abstracts and yielded 43 articles, which the Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel reviewed for relevancy. Twenty-five articles were considered to have met the search strategy, and the panel methodologist assigned ratings to them according to the level of evidence. Results Only 2 of the 25 articles identified met the criteria for level I evidence. Eighteen of the studies did not assess motility after enucleation surgery, and the 7 that did evaluate this metric involved porous implants. The studies that analyzed this outcome reported favorable results, but the results were not uniformly based on objective analysis. Both porous and nonporous implants were well tolerated, and complication rates were generally low for both types. Conclusions In keeping with increasing surgeon preference for porous implants, most studies identified in this literature search involved the use of this type of implant. These implants resulted in excellent motility after enucleation surgery, although many studies did not assess this outcome. Regardless of implant type, major complications were rare, and infection was exceptionally uncommon after enucleation. Given the paucity of data on motility and the absence of direct, objective comparisons of porous and nonporous implants, definitive conclusions about the impact of implant material on motility cannot be made. Since few studies evaluated nonporous implants, direct comparisons cannot be made definitively between implant types, and future investigations are needed to enable a critical assessment.

Mid-face augmentation via a Le Fort I osteotomy is a commonly performed operation. Advancement of the upper jaw and associated structures (nose, lower cheek areas) can certainly improve function as well as facial aesthetics and harmony. Often, in patients with severe mid-face deficiency, hypoplasia of the maxilla extends all the way up to the infraorbital rims. The receding infraorbital rim contributes to the negative vector of the globes. In patients with this level of mid-face hypoplasia, while advancing the maxilla at the Le Fort I level satisfies all of the requirements for orthognathic surgery, the deficient infraorbital rim remains unchanged and can actually accentuate the negative vector of the globes. This article explains our approach in augmentation of the deficient infraorbital rim using alloplastic silicone implants at the time of a Le Fort I osteotomy.

Virtual surgical planning (VSP) has recently been introduced in craniomaxillofacial surgery with the goal of improving efficiency and precision for complex surgical operations. Among many indications, VSP can also be applied for the treatment of congenital and acquired craniofacial defects, including orbital fractures. VSP permits the surgeon to visualize the complex anatomy of craniofacial region, showing the relationship between bone and neurovascular structures. It can be used to design and print using three-dimensional (3D) printing technology and customized surgical models. Additionally, intraoperative navigation may be useful as an aid in performing the surgery. Navigation is useful for both the surgical dissection as well as to confirm the placement of the implant. Navigation has been found to be especially useful for orbit and sinus surgery. The present paper reports a case describing the use of VSP and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant.

Resume Introduction L’evisceration est une intervention chirurgicale dont le but est l’ablation du contenu orbitaire tout en conservant la sclere. Elle permet d’obtenir des resultats esthetiques satisfaisants apres la mise en place d’une prothese oculaire. Note technique L’evisceration sur table comporte 3 temps operatoires : (1) l’ablation du globe oculaire apres section du nerf optique (enucleation) ; (2) l’ablation du contenu du globe sur table operatoire (evisceration) et (3) l’implantation dans la cavite orbitaire d’un implant d’hydroxyapatite enveloppe par la sclere afin de conserver le volume orbitaire. Discussion L’evisceration est indiquee en cas d’œil non voyant, douloureux et inesthetique ne pouvant etre conserve. Contrairement a l’enucleation, l’evisceration a l’avantage de conserver la sclere du patient. L’evisceration sur table est une technique simple permettant d’apporter un volume suffisant et de permettre la realisation d’une prothese oculaire mobile grâce a la mise en place d’une bille d’hydroxyapatite dans la coque sclerale du patient et a la reinsertion des muscles oculomoteurs.

This article describes a straightforward technique for indexing the ocular part of an orbital prosthesis from the anterior aspect. The iris of the ocular portion remains unaffected while using this technique. There is no damage to the moulage as indexing is done from the anterior aspect. This technique provides stability, prevents rotation of the ocular portion, and allows the moulage to be used multiple times. It is cost effective and requires minimal manipulation during processing.

An ocular prosthesis must be maintained in a suitable state of cleanliness, fit and preservation. Otherwise its functioning may be compromised, leading to a variety of diseases. However, there is a lack of consensus on the care of such prostheses. This review assembles and attempts to update existing knowledge in this area and discusses the most appropriate care regimes.

Ceramics are an extremely versatile class of materials with an extraordinarily broad spectrum of applications, ranging from building industry to medicine. Ceramics began to be systematically investigated as implantable biomaterials in the 1950s and soon revealed surprising properties. Orthopaedics and dentistry are the preferred areas of surgical applications of ceramics, due to their suitable strength for load-bearing applications, wear resistance ( e.g. alumina and alumina/zirconia composites) and, in some cases, bone-bonding ability ( e.g. hydroxyapatite and bioactive glasses). Another clinical field where ceramics are playing a significant role is oculo-orbital surgery, a highly interdisciplinary medical area that focuses on the management of injured eye orbit, with particular regard to the repair of orbital floor/wall fractures and/or the placement of orbital implants after removal of a diseased eye. Especially in the latter case, implants are not intended for bone repair but have to be biointegrated in soft ocular tissues; therefore, suitable ceramics for this application are required to go beyond the “traditional” bone-bonding ability. This article provides a picture of the currently-used ceramics for such applications and explores new emerging perspectives, highlighting the promises for the future disclosed by the recent advances in nanobioceramics science.

Objective Clinical outcomes for enucleation vary widely, depending on surgical technique, implant choice, and indications for enucleation. The goal of this study was to compare complications of enucleation using hydroxyapatite versus polyethylene orbital implants for 1 indication: uveal melanoma in adults. Design Retrospective chart review Participants Consecutive case series of patients who were enucleated for uveal melanoma by a single surgeon (J.W.H.) from 1999-2009. Methods A retrospective chart review was performed to record clinical and histopathologic features, surgical technique, orbital implant characteristics, and outcomes in a consecutive series of patients with uveal melanoma who were treated by enucleation by a single surgeon (J.W.H.) between 1999 and 2009. Results This study included 139 patients; 64 received hydroxyapatite implants, and 75 received polyethylene implants wrapped in donor sclera. Complications included blepharoptosis in 4 (2.9%), conjunctival cyst in 2 (1.4%), volume deficit in 2 (1.4%), implant exposure in 1 (0.7%), and conjunctival erosion in 1 (0.7%) patient. There were no significant differences in the clinicopathologic features or complications between the 2 groups. Conclusions Few complications were encountered using this enucleation technique, and there was no difference in complication rates between patients receiving hydroxyapatite and polyethylene implants.

Summary Introduction The purpose of this study is to analyse the 2-stage Muller's muscle flap technique for the treatment of orbital implant exposure and its results. Materials and methods This retrospective study reviewed all patients undergoing surgery using this technique in our university hospital over a 14-year period (1999–2012) in terms of success (no re-exposure of the implant) or failure. Results Nineteen patients were managed using this 2-stage procedure. Orbital implant exposure occurred 94.4 months (2–240) after implantation. The success rate was 68.4% (13/19) and failure rate 31.6% (6/19). Risk factors for exposure were enucleation for melanoma followed by radiation therapy, acrylic implant, and early exposure probably due to excessive suture tension. Discussion Implant exposure is the most common complication after evisceration, enucleation or socket surgery. Several techniques to repair exposures have been described. Two-stage Muller's muscle flap is an interesting option, especially for patients presenting defects larger than 4 mm 2 and without previous radiation therapy treatment. Conclusion The two-stage Muller's muscle flap procedure allows for an autologous vascularized pedicle flap from the ipsilateral upper eyelid. It is a reliable technique with a success rate of 68% in our study.

Objective To determine the risk factors for primary implant exposure after enucleation and evisceration in infected eyes. Design Retrospective, comparative case series. Participants Patients who underwent enucleation or evisceration for infected eyes. Methods Records of patients who underwent enucleation or evisceration for infected eyes with placement of solid sphere implants were reviewed. Preoperative white blood cell (WBC) count, microbiologic laboratory results, clinical features, medical treatment, and surgical methods were recorded to evaluate the risk for implant exposure. Results Eighty-five infected eyes were collected. The mean age was 70.1 years. The positive culture rate was 69.4%. In 42 patients with endophthalmitis or panophthalmitis, the most common microorganisms were Pseudomonas aeruginosa in 6 cases (20.7%) and Klebsiella pneumoniae in 7 cases (24.1%). In 50 patients with keratitis or scleritis, the most common microorganisms were P. aeruginosa in 14 eyes (46.7%) and Fusarium in 4 eyes (13.3%). There was a 12.9% exposure rate for the 85 patients. Preoperative WBC count was significantly higher in patients with implant exposure compared with those without exposure ( p = 0.04). Preoperative WBC count more than 9500 cells/L had significantly higher exposure ( p = 0.001). Conclusions Preoperative elevated WBC count was associated with higher risk for implant exposure. Primary implantation after enucleation or evisceration may be less safe in infected eyes with high preoperative WBC count.

Rapid vascularization and long-term antibacterial property are desirable characteristics of the next-generation implants in orbital reconstruction. In this study, the new diopside-based orbital implants were developed by direct ink writing of diopside (CaMgSi2O6; DIO) and low-melt bioactive glass (BG)-assisted sintering approaches. The mechanical tests showed that the addition 5% or 10% BG could readily enhance the compressive strength of the DIO porous bioceramics after sintering at 1150 °C. The Tris buffer immersion test in vitro indicated that the porous bioceramics exhibited appreciable mechanical stability and very limited mass loss (

Pattern formation is the most difficult and demanding step in the fabrication of a facial prosthesis. Traditionally, the pattern fabrication of an orbital prosthesis begins with the adaptation of softened base plate wax on the cast, over which the entire pattern is fabricated. However, owing to the inherent properties of wax, such as distortion and stress relaxation, incorporating discrepancies in the pattern adaptation is likely. This article describes a vacuum-formed polyvinyl chloride sheet to fabricate a durable, distortion-free base for pattern fabrication, thereby overcoming the drawbacks associated with a wax base.

Purpose To evaluate the reported use and outcomes of implant materials used for the restoration of post-traumatic orbital floor defects in adults. Materials and Methods A systematic search of the English literature was performed in the databases of PubMed, Cochrane Library, and EMBASE. The study selection process was adapted from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, and 55 articles complied with the study inclusion criteria. The primary outcome measures were diplopia, enophthalmos, graft extrusion/displacement, and infection related to the graft material. The secondary outcome measures were infraorbital paresthesia, orbital dystopia, orbital soft tissue entrapment, and donor-site complications. Results Of 55 articles, 41 (74.5%) evaluated were retrospective case series, 9 (16.4%) were retrospective case-control studies, 3 (5.5%) were controlled trials, and 2 (3.6%) were prospective case series. Autogenous graft materials were predominantly used in 19 studies, alloplastic materials were used in 33 studies, and the remaining 3 articles reported on allogeneic materials. Overall, 19 different types of implant materials were used in 2,483 patients. Of 827 patients with diplopia before surgery, 151 (18.3%) had diplopia postoperatively. Of 449 patients with enophthalmos before surgery, 134 (29.8%) had enophthalmos postoperatively. Only 2 patients (0.1%) and 14 patients (0.6%) had graft extrusion/displacement and infection related to the graft material, respectively; alloplastic biomaterials were used in all of these cases. Conclusions All graft materials used were successful to variable degrees because all studies reported improvement in terms of the recorded outcome measures. A guideline for choice of implant material based on defect size was developed.

Ablative surgery of the orbit is often associated with dramatic changes in facial geometry. Surgical intervention is often necessary to correct the functional and esthetic appearance in those patients who are anophthalmic, having an intact eyelid appearance and an orbital prosthesis. The outcome of the surgical correction depends on the shape of the orbital implants and their adequate placement. In the case of comparatively small rearrangements, the effect of implants on soft tissues can be estimated by surgeons on the basis of their experience. However, large deformities in complex cases (including large deformation of soft tissue or asymmetry) can be hardly predicted on the basis of simple empirical considerations. The purpose of the present technical note was to describe a new procedure of inverse design of customized orbital titanium meshes. To demonstrate this procedure, an anophthalmic patient with superior sulcus deformity and enophthalmos was enrolled. The volume and structure of the extraocular muscles, soft tissue, and bony structure of the orbital walls were examined using high-resolution multislice computed tomography. Next, a geometric model of the patient's anatomy was generated from the tomography data. Afterward, the orbital prosthesis was virtually relocated to a new position. Then, the desired correction of the particular soft tissue regions was performed using virtual sculpturing tools. Next, the deformation of the soft tissues and initial prosthesis boundaries were computed from the predefined displacements of the relocated tissue regions with the help of the Finite Element Method. The differential volume between the initial and designated position of the orbital prosthesis yielded the preferred implant shape required to effect the desired correction of soft tissue. During surgery, the preplanned position of the customized titanium meshes was guided using a navigation system. Although the inverse design of custom-tailored titanium meshes for precision treatment of severe enophthalmos in anophthalmic patients appears to be a promising approach, it has rarely been applied in the past because of the technological complexity and additional time required. With the present study, we have launched a series of clinical evaluations of this novel method. To date, scientific evidence and trials showing a predictable simulation using an inverse finite element approach in the correction of severe enophthalmos in anophthalmic patients with computer-assisted fabricated individual titanium meshes for reconstruction of orbital walls have been rare.

Orbital tumor, trauma, and necrosis require the orbital contents to be resected and the patient is left with a cosmetic deformity that affects a patient's self-image and those around him or her. Careful planning between the oral and maxillofacial surgeon and/or oculoplastic surgeon and the maxillofacial prosthodontist will result in a secure and accurate esthetic reconstruction using an implant-supported prosthesis. The multiple steps involved in this process require the commitment of doctors and patient. This article reviews surgical and prosthetic considerations in providing a satisfactory esthetic reconstruction of a variety of orbital defects.

Purpose To evaluate the effectiveness of navigation-guided surgical correction as the treatment of midfacial post-traumatic deformities. Patients and Methods A total of 40 patients with midfacial post-traumatic deformities from 2007 to 2010 were involved in the present study. The preoperative planning and simulation data sets, including the generation of virtual models with the mirror tool, were used as a virtual template to guide surgical correction of those deformities by intraoperative instrument- and/or probe-based navigation. The outcome was checked by both superimposing the postoperative 3-dimensional computed tomography model on the preoperative planning model and clinical examination. Results Through registration, an accurate match between the intraoperative actual position and 3-dimensional virtual model was achieved with a systematic error of 1 mm difference. With the guidance of the navigation system, the average deviation of the morphologic change after surgical correction was less than 1 mm according to the image comparison between the preplanned and postoperative computed tomography. The 1- to 2-year follow-up evaluation showed that the clinical complaint symptoms were alleviated, and the postoperative function and esthetics improved remarkably. Conclusions Navigation-guided correction in the treatment of midfacial post-traumatic deformities can be regarded as an ideal and valuable option for this potentially complicated procedure.

To determine the impact of chemotherapy or external beam radiotherapy (EBRT) on pediatric anophthalmic sockets.A retrospective, nonrandomized, interventional cohort study.A total of 135 sockets of 133 children undergoing enucleation from late 1999 to early 2009 at the St. Jude Children's Research Hospital were included.A retrospective chart review of outcomes after enucleation in patients treated with systemic chemotherapy or orbital EBRT either before or after removal of the eye compared with patients who received no other treatment.Incidence of implant exposure, migration, extrusion, socket contracture, and pyogenic granuloma formation.Retinoblastoma was the primary diagnosis in 128 eyes (95%). Median follow-up was 3.6 years (range, 0.1-9.3 years). Event-free course was observed in 94 sockets (69.6%). Complications included implant exposure (n = 28, 20.7%), socket contracture (n = 16, 11.9%), pyogenic granuloma (n = 9, 6.7%), implant extrusion (n = 3, 2.2%), and migration (n = 2, 1.5%). Exposure resolved in 21 sockets (77.8%) and improved in 2 sockets (11.1%); 1 patient with exposure died. Use of prior, adjuvant, or subsequent chemotherapy increased the long-term risk of exposure (odds ratio [OR] = 3.7; 95% confidence interval [CI], 1.4-9.4), and contracture (OR could not be calculated, P0.0001). External beam radiotherapy greatly increased the risk of contracture (OR 24.0; 95% CI, 6.9-82.8) and exposure (OR 2.89; 95% CI, 1.1-7.9).In this unique pediatric population with cancer, chemotherapy and EBRT had an additive effect, significantly increasing the incidence of exposure and socket contracture.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Statement of problem The tissue surrounding craniofacial implants is prone to inflammation; however, no adequate instrument is currently available to measure this objectively. Purpose The purpose of this study was to describe the parameters influencing the sulcus fluid flow rate in the extraoral periimplant tissue environment. Material and methods Thirty-four patients with 112 craniofacial implants participated. The sulcus fluid flow rate (SFFR) was measured with standardized paper strips. The influence of cleansing liquids, implant location, presence of purulent exudates, smoking habits, depth of crevice, and previous irradiation on the sulcus fluid flow rate were evaluated with covariate adjusted finite mixture models. Results Two latent subgroups of SFFR were identified based on a mixed model. The majority (95.5%) had a mean value of 1.44 mm, and the smaller subgroup (4.5%) had a mean value of 10.4 mm. The SFFR values were increased when purulent exudates were present (regression coefficient 1.41), 95% CI (0.67, 2.16). The depth of the crevice influenced the SFFR per unit depth (regression coefficient 0.37), 95% CI (0.22, 0.53). Additional covariates, such as the implant location, history of smoking, and prior irradiation, had no statistical effect on SFFR. Conclusions SFFR can be measured objectively in the extraoral periimplant tissue.

Maxillofacial prostheses are constructed by maxillofacial prosthetists and technologists (MPTs), as an alternative treatment when maxillofacial defects cannot be surgically fulfilled. A questionnaire was conducted surveying 220 MPTs working in all UK maxillofacial units about their opinions, attitudes, and experience regarding several aspects related to maxillofacial silicone prostheses. Numbers and percentages of maxillofacial prostheses, their retention method, serviceability, reduced serviceability causes, and digital technologies (DT) used in constructing prostheses were analysed. Thousand hundred and ninety-three prostheses were constructed (42% ocular, 31% auricular, 13% orbital, 12% nasal, 1% composite, more than one facial prosthesis). Adhesives commonly retained orbital (48%) and nasal (45%) prostheses. Implant-retained bars commonly retained auricular prostheses (70%). Ocular prostheses were entirely retained by undercuts. Implant-retained prostheses remained serviceable for twice as long (19-24 months) as adhesive-retained prostheses (7-12 months). Causes for prosthesis replacement included colour changes (71%), poor maintenance (41%), and silicone tear (37%). Thirty-one percent of MPTs used DT computer software and programs for designing and constructing maxillofacial prostheses. In conclusion, adhesives, implant-retained bars and magnets are commonly used retentive methods. Prosthesis failure is caused mainly by colour change, poor maintenance, silicone tear and delamination. Different DTs are used by one-third of MPTs.

Inter-individual size and shape (form) variation for the orbital floor and medial wall was assessed and compared with its posterior partition. Reconstruction of the posterior partition is known to be a surgical challenge in complex orbital defect repair when using standard manual implant contouring and positioning techniques. The size variation of both regions was assessed, alone and combined, in statistical form analysis using three-dimensional computer models of left and mirrored right orbits, obtained from 70 clinical computed tomography (CT) scans of adult European Caucasians with unaffected orbits. Major shape and size variability for both regions was observed, but to a larger extent for the entire orbital floor and medial wall, with males having significantly larger regions but with no differing shape patterns. Statistical modeling was used to identify characteristic shape patterns in given orbits. The size, shape and positioning of precontoured implants are decisive criteria for the adequate repair of complex orbital defects. The results indicate that optimal form conditions for prefabricated implants exist in a restricted area corresponding to the transition of the posterior orbital floor and medial wall.

Purpose Orbital trapdoor fractures are pure orbital floor fractures with herniation and entrapment of the orbital contents, leading to restricted eye movement and diplopia. Trapdoor fractures in children have been discussed widely in published reports; however, the treatment policy and outcome remain controversial, although early treatment has been advocated. Our retrospective study analyzed the long-term results of pediatric patients undergoing surgery for trapdoor fractures to determine the outcome in relation to the type of fracture and the timing and technique of intervention. Patients and Methods The present study included 24 patients (age range 6 to 16 years) who underwent surgery for trapdoor fractures from 1998 to 2007. The demographic, etiologic, radiologic, and surgical findings, interval between trauma and surgery, surgical techniques, and complications were recorded. Diplopia, ocular motility, dysesthesia, and scar quality were recorded at follow-up. Results The follow-up duration averaged 36 months. At follow-up, 1 (8.3%) of 12 patients who underwent surgery within 24 hours (urgent treatment) had residual diplopia. In contrast, 3 (37.5%) of 8 patients who underwent surgery 24 to 96 hours (early treatment) and 4 (100%) of 4 who underwent surgery after 96 hours (late treatment) had diplopia. No sensory deficit of the skin or unesthetic eyelid scar was noted. Conclusions We found a correlation between the outcome and the timing of surgery for trapdoor fractures in the pediatric population. The success rate was significantly better when the fractures were treated within 24 hours of the injury. The results of the present study have strengthened the assertion that trapdoor orbital fractures pose a true surgical emergency.

Summary Various materials for the reconstruction of bone defects in orbital floor fractures have been developed and applied clinically. Recently, reconstruction using polymers, in place of autologous bone and artificial materials, has been actively introduced, but there are problems, such as the size of reconstructable bone defects and the decomposition rate of polymers. A basic study was performed on bone regeneration using a periosteum–polymer complex produced by attaching periosteum to a biodegradable polymer sheet. In this study, patients with orbital floor fractures were evaluated clinically who had undergone reconstruction of orbital floor defects of the using a periosteum–polymer complex produced by applying periosteum to an Hydroxyapatite-[poly (l-lactide–ɛ-caprolactone)](HA-P (CL/LA)) sheet and the ilium in the previous 3 years. A bone defect of less than 2.5cm 2 area was defined as small, that of 2.5–4cm 2 as intermediate, and that of more than 4cm 2 as a large bone defect. For small bone defects, hypoaesthesia in the infraorbital nerve was observed in one patient each of the periosteum–polymer complex and ilium groups. Regarding intermediate bone defects, diplopia and hypoaesthesia in the infraorbital nerve were observed in one patient in each of the two groups. For large bone defects, diplopia was observed in one patient each for the periosteum–polymer complex and ilium groups, and hypoaesthesia of the infraorbital nerve was only detected in one patient of the former group. Not more than 2mm of enophthalmos was detected in any patient. The anatomical eyeball position and eyeball movement were normal after surgical treatment using the periosteum–polymer complex, just as in reconstruction using autologous bone.

Much has been written about the repair of orbital fractures, yet some debate still exists among surgeons with regard to indications for and timing of fracture repair and various surgical techniques. Controversies regarding the surgical maneuvers include the incision, surgical approach, and methods of wound closure. More detailed imaging modalities have allowed clinicians to understand the injuries more completely and plan for and execute more ideal reconstructions. Recent advances in orbital implant materials and the role of endoscopy in orbital fracture repair add to this debate about which techniques would be best for particular injuries. This article discusses these issues and provides the most current literature review regarding the management of various orbital fractures.

Resume But Evaluer l’apport de l’IRM dans la surveillance de la biocolonisation des implants intra-orbitaires. Patients et methode Nous avons mene une etude retrospective incluant 10 enfants (10 yeux) ayant eu une enucleation pour un retinoblastome evolue. Les implants etaient tous en hydroxyapatite de synthese. Nous avons realise une IRM en postoperatoire a des delais differents allant de 2 mois a 1 an. L’exploration orbitaire a comporte, pour chaque patient, des sequences ponderees en T1 sans et avec injection de Gadolinium dans les plans axial et sagittal. Resultats L’IRM montrait une prise de contraste de l’implant dans cinq cas, une prise de contraste nodulaire autour de l’implant en rapport avec une recidive du retinoblastome dans un cas, et une absence de prise de contraste dans quatre cas. La prise de contraste de l’implant etait peripherique dans deux cas et etendue au centre dans trois cas. Une dissemination meningee a ete notee dans deux cas, mais aucun cas de rejet de l’implant n’a ete detecte. Conclusion La colonisation fibrovasculaire de l’implant orbitaire reduit le risque d’expulsion et permet d’assurer une meilleure mobilite de la keratoprothese superficielle. L’IRM est un moyen sensible pour objectiver cette biocolonisation et l’integration de l’implant orbitaire.

Purpose To review the clinical and histopathologic features of porous polyethylene (PP) orbital implants requiring explantation. Design Case series. Participants Eighteen explanted PP orbital implants of 18 patients were studied. Methods The charts and histopathologic findings were reviewed for all patients requiring explantation of PP orbital implants between 1997 and 2006 by 2 oculoplastic surgeons at the University of British Columbia. Main Outcome Measures Clinical data obtained included patient demographics, the nature of the primary surgery, and the clinical presentation leading to eventual implant removal. The histopathologic data observed included the presence of anterior exposure, area of fibrovascular ingrowth, type of inflammation, and presence and type of bacterial colonies. Results Nine (50%) of the 18 patients studied were referred from other surgeons. The balance represented 3.2% of all PP implants placed by the 2 surgeons. The procedures for the primary surgery were 12 enucleations (67%), 5 eviscerations (28%), and 1 secondary implant (5%). Clinical findings included anterior implant exposure and discharge in all cases. Histopathologic analysis was performed in all of the implants and showed less than 50% fibrovascular ingrowth in 16 implants (89%) and predominantly acute or mixed inflammation in 15 (83%). Foreign body giant cells were seen adjacent to the implant material in all cases. Bacterial colonies on gram stain were identified in 12 specimens (67%); overall, gram-positive cocci in clusters or chains were found in 10 implants (56%), and gram-negative bacteria were found in 1 (5.5%). Thirteen patients (72%) lived in locations distant from Vancouver, the surgical center. Conclusions This article presents the largest review of explanted porous polyethylene orbital spheres. The findings suggest that anterior exposure allows bacterial colonization and the development of a heavy inflammatory infiltrate. Poor tissue ingrowth may limit the penetration of topical or systemic antibiotic therapy, leading to the necessity for explantation. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose Infraorbital blow-out fracture (IOBF) is an uncommon midfacial trauma, and impairs eyeball function and causes esthetic problems. The extraoral approach can lead to some complications such as scarring, ectropion, and entropion. The intraoral approach, such as a transantral approach, has advantages such as no visible scaring, it can be used to simultaneously treat a zygomaticomaxillary complex fracture (ZMCF), and the procedure is relatively easy. Patients and Methods IOBFs were reduced from the maxillary sinus, and fixated internally using miniplates and screws with/without Medpor (Porex, Newnan, GA) via a transantral approach. We used this technique in 11 patients who had an inferior blow-out fracture. Patient's records and CT scans were reviewed. Results The mean age of the patients was 37 years (ranging between 15 years and 68 years). The mean follow-up period was 9.8 months, which ranged from 1 to 24 months. Before the operation, the patients had orbital symptoms: diplopia in 3 patients; enophthalmos in 4; and gaze limitation in 3. All the patients showed periorbital swelling and ecchymosis. After surgery, none of the patients had diplopia, gaze limitations, and enophthalmos. There were no orbital symptoms or sinus symptoms due to an infection or allergic reaction after surgery except in 1 patient. In 1 patient, maxillary sinusitis developed at 4 months after surgery which subsided with antibiotic therapy after plate removal. Conclusion We think this technique offers an easy approach, and produces reliable, satisfactory results in IOBF.

This article describes an impression technique to transfer implant positions to the definitive cast using magnetic attachments splinted with acrylic resin for an implant-retained orbital prosthesis. The acrylic resin transfer device that incorporated the magnets was also used as the acrylic resin magnet substructure for the silicone orbital prosthesis. (J Prosthet Dent 2008;100:52-55)

The aim of this retrospective study was to describe the oral procedures used in osteo-odonto-keratoprosthesis (OOKP) surgery, and the demographics and oral findings of candidate patients in Singapore. The OOKP procedure utilizes an autologous tooth-bone complex to mount a poly-methylmethacrylate optical cylinder, as an artificial cornea, stabilized by an overlying autologous buccal mucosal graft. Consecutive patients referred over 3 years for dental evaluation prior to OOKP surgery were included. A total of 21 patients underwent oral clinical and radiographic evaluation. The aetiology of blindness included Stevens-Johnson's syndrome (11 cases), chemical burns (9 cases) and multiple failed corneal grafts (1 case). Evaluation revealed that 12 patients were suitable for OOKP surgery, 8 were at risk of complication or failure and 1 had no usable teeth. Fourteen patients have undergone unilateral OOKP Stage 1 surgery successfully. Complications included fracture of a tooth from its lingual bone necessitating the harvesting of a second tooth (1 case), oronasal perforation (1 case), exposure of adjacent roots (5 teeth), lower lip paresthesia (2 cases) and submucosal scar band formation in the buccal mucosal graft donor site (10 cases). Thirteen patients have completed Stage 2 surgery, with attainment of their best possible visual potential following OOKP surgery.