Journal of Interdisciplinary Dentistry

CASE REPORT
Year
: 2019  |  Volume : 9  |  Issue : 3  |  Page : 135--138

Prosthetic rehabilitation of an orbital defect: A clinical report


Preethi Kusugal1, VN Kalaivani2, Viraj Patil1, Vankadara Sivakumar3,  
1 Department of Prosthodontics, Maratha Mandal's N. G. Halgekar Institute of Dental Sciences and Research Centre, Belagavi, Karnataka, India
2 Consultant Prosthodontist and Implantologist, Thennamanadu, Orathanadu Taluk, Thanjavur, Tamil Nadu, India
3 Department of Prosthodontics, Government Dental College and Hospital, RIMS, Kadapa, Andhra Pradesh, India

Correspondence Address:
Dr. Preethi Kusugal
Department of Prosthodontics, Maratha Mandal's N. G. Halgekar Institute of Dental Sciences and Research Centre, Belagavi, Karnataka
India

Abstract

Prosthetic rehabilitation of an orbital defect plays an important role in restoring aesthetics of the face. The eye is a vital organ, the loss of which requires a tailored approach for postdefect rehabilitation. Advance treatment modalities such as implant-supported orbital prosthesis have a superior outcome in terms of retention and esthetics, but due to economic factor, it is not affordable for all patients. This case report describes a simplified method for the rehabilitation of a patient with an orbital defect where retention is obtained by eyeglasses achieving satisfactory esthetics.



How to cite this article:
Kusugal P, Kalaivani V N, Patil V, Sivakumar V. Prosthetic rehabilitation of an orbital defect: A clinical report.J Interdiscip Dentistry 2019;9:135-138


How to cite this URL:
Kusugal P, Kalaivani V N, Patil V, Sivakumar V. Prosthetic rehabilitation of an orbital defect: A clinical report. J Interdiscip Dentistry [serial online] 2019 [cited 2021 Jan 23 ];9:135-138
Available from: https://www.jidonline.com/text.asp?2019/9/3/135/273658


Full Text



 Clinical Relevance to Interdisciplinary Dentistry



An economical approach to fabricate spectacle retained orbital prosthesis using implant mounts has been presented. This method is useful in patients exhibiting shallow orbital defects and more comfortable to the patient as it could be removed with the spectacle easily.

 Introduction



Any facial disfigurement secondary to carcinoma or any other trauma to the face would have an impact on the psychological status of the individual.[1] Rehabilitation of orbital defect often poses a challenge in orientation and retention of the prosthesis. The size of the orbital defects following exenteration is larger in dimensions as compared to ocular defects as there is loss of eyeball and the orbital contents. Many authors have suggested various methods for accurate orientation of an eye shell within the orbital prosthesis such as facial measurements,[2] graph grid,[3],[4] and facebow.[5],[6] The selection of appropriate retentive aid determines the success of the orbital prostheses. The amount of retention for the prostheses depends on the size and extension of the defect,[7] amount of remaining bone, and presence or absence of anatomic undercuts in the defect.[2],[8] The commonly used mode of retention for orbital prostheses is adhesives,[9],[10] spectacles,[11],[12] magnets,[13],[14] and maxillofacial implants.[15],[16],[17] Due to the economical constraints of the patients, implants are often not considered in the rehabilitation of orbital defects. This paper describes a technique wherein implant mounts were utilized to attach the orbital prosthesis to eyeglasses to aid in the retention of the prosthesis.

 Case Report



A 57-year-old female patient reported to the Department of Prosthodontics, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belagavi, Karnataka, India, with the chief complaint of missing right eye and desired it to be replaced. The patient gave a history of carcinoma of the right eye 5 years back. Orbital exenteration was performed subsequently to control invading tumor. Visual examination revealed loss of eyeball, anterior orbital tissue, lateral wall, floor of the orbit, and inferior orbital rim.[18] The defect was found to be shallow with the intact lower eyelid having coordinated movements with the adjacent eye [Figure 1]. Since the defect depth was not sufficient enough to provide retention for the prosthesis and considering the patient's economic status, it was decided to fabricate eyeglass-retained orbital prosthesis.{Figure 1}

Impression procedure

The impression area was outlined with putty elastomeric impression material (Aquasil, Soft Putty/Regular set, Dentsply, Germany) to confine the margins. The impression of the orbital defect was made using irreversible hydrocolloid (Tropicalgin, Zhermack, Italy). A thin layer of plaster mix was added over the impression to avoid distortion of irreversible hydrocolloid while pouring with dental stone (Goldstone, Type III, Asian chemicals, Gujarat, India). A commercially available acrylic eye shell matching the sclera and iris color of the patient's left eye was selected from an eye shell kit. The size of the ocular prosthesis was adjusted according to the size of the defect.

Orientation of the eye shell

The patient was made to sit at a relaxed gaze. Nasion was used as a reference point; it was marked on the patient. A rim was prepared around the borders of the defect using heat-cured acrylic resin [Figure 2] and tried on the patient for proper adaptation. Two implant mounts were incorporated in the resin rim. A vernier calliper was used to measure the distance from nasion to pupil of the left eye, and then, the same measurement was made on the defect side. With these arbitrary markings, the interpupillary distance was measured. The eye shell was oriented to the model according to the measurements obtained by vernier calliper. Wax sculpting was completed with its borders adapting to the resin orbital rim. The wax pattern was tried on the patient and further confirmed with vernier calliper. The trial frame was used to determine the pupillary axis; orientation, positioning, and the distance from outer border of the trial frame to the wax pattern, i.e., anteroposterior relation were compared with the left natural eye [Figure 3].{Figure 2}{Figure 3}

Silicone prosthesis fabrication

A 2 ml syringe needle cap was cut up to 4 mm height. It was placed above the eye shell and filled with auto cure clear autopolymerizing resin (DPI, Mumbai, India) to aid in stabilization. The model with the wax pattern was invested, and dewaxing was carried out. Shade matching was done using specific stains provided by the manufacturer for silicone (Factor II LSR silicone), and it was mixed with base paste and applied in layers on to the mold to avoid incorporation of air bubbles. After retrieval, the prosthesis was finished and polished and then tried in the patient's defect for proper fit. Then the nose pad area and sidearm of the eyeglasses, which is in contact with the silicone were attached to the implant mounts [Figure 4] and [Figure 5]. Eyeglasses retained orbital prosthesis was inserted into the defect [Figure 6], and postinsertion instructions were given to the patient for maintenance.{Figure 4}{Figure 5}{Figure 6}

 Discussion



In the present case report, due to inadequate undercuts to retain the prosthesis, there was a need to use the auxiliary retentive aids. As the patient was spectacle wearer, implant mounts were used to attach orbital prosthesis to the spectacles which were, in turn, used to retain the entire prosthetic assembly on the face, thus restoring the patient's natural appearance. Guttal et al.[4],[11],[12] described the use of eyeglasses and resin base to retain orbital prosthesis. Gupta et al.[19] have described the use of customized scale to position the iris in customized ocular prosthesis. In this patient, the orientation of an eye shell to the defect was verified through the use of a trial frame. This trial frame is generally used in the ophthalmology as a routine diagnostic tool. It has calibrations all around which was used to assess the proper positioning of eye shell in the wax pattern. The combined use of vernier calliper for measuring nasion-pupillary distance and the trial frame for the orientation of the eye shell in the same relation as the natural eye yielded better symmetry and esthetics in the patient.

 Conclusion



A new method of using ophthalmic trial frame for the orientation of eye shell in the orbital prosthesis and implant mounts to retain orbital prosthesis to the eyeglasses has been described. This spectacle retained prosthesis ensures adequate retention and more comfort to the patient affecting the psychological status more positively.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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