Open and closed frontal and lateral radiographs a—d show the lower arm of the device arrows moves with the eyelid Fig. Axial a and sagittal b CT images show the inferior limb of the spring positioned within the upper lid arrows 5. It is also used as a surgical approach to the lateral orbit.
The procedure involves incising the lateral canthus of the eyelids and releasing one or both lateral canthal tendons. On imaging, disruption of one or both lateral canthal tendons can be discerned, and increased proptosis and herniation of orbital contents may be observed after the procedure Fig.
Canthopexy, on the other hand, consists of repairing or reattaching the canthal tendons. Occasionally metallic anchors, such as wire or screws, may be used to affix the ligament to the underlying bone, which should not be mistaken as an unintended foreign body on imaging Fig.
Axial CT image shows a surgical defect in the left lateral canthal region arrow with mild anterior herniation of orbital fat and proptosis Fig. Axial a and sagittal b CT images show a metallic density structure embedded within the left frontal process of the maxilla arrows 5.
In particular, growth of the orbit during early childhood is dependent on the presence and growth of the orbital contents. If untreated, an anophthalmic socket in a young child will result in a disproportionately small orbit and sometimes entire hemifacial bone structure compared to the contralateral side. Traditional methods for orbital expansion include using progressively enlarging static acrylic conformers, insertion of conventional static spherical orbital implants, dermis-fat grafts, or inflatable balloon expanders for orbital enlargement.
However, these techniques may still result in suboptimal cosmetic outcomes, with delayed growth of the bony orbit and overlying soft tissues. Another option for stimulating bone growth in an anophthalmic socket is an integrated orbital tissue expander comprised of an inflatable silicone globe on a sliding titanium T-plate secured to the lateral orbital rim with screws Fig. The sphere can be inflated via transconjunctival injection of saline.
Saline expanders appear as spherical sacs containing fluid attenuation on CT adjacent to the metal density T-plate Fig. Hydrogel tissue expanders are an alternative therapy for the anophthalmic socket. The expanders are inserted in a dry, contracted state and expand gradually to full size via osmosis of fluid from surrounding tissues, with up to a tenfold increase in volume. Hydrogel orbital expanders are available in the form of spheres and hemispheres Fig.
Hydrogel expanders appear as nearly fluid attenuation on CT due to the high water content. The increased orbital volume provided by the use of these devices can be delineated on imaging. Preoperative axial CT image a shows a small left orbit. Postoperative axial CT image b shows a saline-filled left orbital expander arrow attached to the lateral orbital rim via the metal plate arrowhead Courtesy of David Tse MD Fig.
The material can be used to increase the orbital volume prior to permanent orbital implant insertion Courtesy of Osmed Fig. Preoperative axial T1-weighted MRI a shows bilateral anophthalmos. Axial b and sagittal c T1-weighted, axial post-contrast T1-weighted d , and axial T2-weighted e , and MR images show bilateral hemispherical hydrogel expanders in position arrows.
The expanders have signal characteristics similar to fluid. Subsequent axial CT image f shows interval placement of bilateral orbital implants 5.
It can complete degree around the globe or segmentally. The device is made of silicone. There are 2 main components: outer solid silicone rubber hyperdense on CT and inner silicone sponge air density on CT. Both are hypointense on T1 and T2WI and radiolucent on plain radiographs. Does an artificial eye move?
In short, yes, but this varies widely amongst patients. Some people have greater movement than others, depending on surgery, muscle development, or trauma. Should I use eye drops? Eye drops should be used if a patient is experiencing discomfort that drops can alleviate, not as a precaution or preventative. If you are not experiencing any discomfort, then there is no need for drops. If you are experiencing discomfort, and have never used drops before, please call our office, as it could also be that the eye needs to be polished or that it needs a fitting adjustment.
An anaplastologist also known as a maxillofacial prosthetist and technologist in the UK is an individual who has the knowledge and skill set to provide the service of fitting and fabricating a completely custom facial craniofacial prosthesis , ocular or somatic prosthesis.
This term refers to prostheses of a portion of the head or neck and includes, but is not limited to, ears auricular , nose nasal , orbital, and hemi-facial prostheses. We also make finger digit prostheses. In most cases, these are made from a silicone rubber. We have different varieties of silicones that we work with, depending on the patients individual needs. Some patients have implants placed to help anchor their prosthesis, in which case there would be reciprocating clips or magnets in the prosthesis.
These all have advantages in addition to restoring anatomy to the patient. For example, an artificial ear can aid in hearing if the patient still has an ear canal, and a mid face prosthesis can help with speech. What is the process of making a new maxillo-facial prosthesis and how soon will I be seen post surgery There are different recovery periods depending on the surgery, and this will be discussed with you by your surgeon and will be relayed to us in the referral.
In general at the first appointment, we will take an impression, make a quick mold of the site, begin a sculpt of the prosthesis, take photos for finish work, and mix color samples. If it is an ear, we will also take an impression of the other ear as reference.
At the next appointment, we will have fabricated a prosthesis to try. At this appointment, we will also teach the patient how to care for, remove and replace the new prosthesis. How is a maxillofacial prosthesis attached? There are three types of maxillofacial prostheses pertaining to the way they are attached - adhesive-held, implant-held, and self-retaining. Some are a combination. An adhesive-held prosthesis is retained by an adhesive made specifically for this purpose.
There are a variety of adhesives, so there are plenty of options to try. An implant-held prosthesis has clips or magnets that attach to implants placed by a surgeon. Self-retaining prostheses may be able to be worn without adhesives or implants. Depending on the bone and tissue structure, the site may have the ability to support the prosthesis How long will a maxillofacial prosthesis last?
This varies widely, but the average range is generally 2 to 6 years. For example, an extremely active child may need replacements more often than an less active adult.
Complications related to eyelid implantation include prominent implants visible through the skin, infection, allergic reaction, migration, and extrusion. At the second appointment, we will have an eye or shell to try. The spring mechanism is sutured to the periosteum of the lateral orbital rim. It is a device designed to treat retinal detachment.
An adhesive-held prosthesis is retained by an adhesive made specifically for this purpose. Hydrogel tissue expanders are an alternative therapy for the anophthalmic socket. Regardless of the implant type, signal changes within the optic nerve remnant on T2-weighted images and atrophy of the nerve remnant and the chiasm are to be expected following enucleation and should not be interpreted as necessarily indicating active pathology Fig.