title: Localization of extraocular muscles during secondary orbital implantation surgery: the tunnel technique: experience in 100 patients.
abstract: OBJECTIVE
  To describe a technique for localizing extraocular muscles during secondary orbital implantation and to report the author's experience in 100 consecutive cases.
  
  
  METHODS
  Retrospective, noncomparative, consecutive case series.
  
  
  METHODS
  A retrospective review was performed of the charts from one surgeon's practice of 100 consecutive patients who received a secondary porous orbital implant for anophthalmic socket rehabilitation. The following data were recorded: age, gender, reason for seeking secondary implantation, type of implant used, size and style of implant used, number of muscles localized, follow-up duration, and problems encountered and their treatment. Preoperative and postoperative photographs, implant motility, prosthetic motility, and overall impressions (by patient and physician) of the surgical outcome were analyzed.
  
  
  RESULTS
  The 100 patients (66 males and 34 females, with a mean age of 38.9 years) were followed up for an average of 16.9 months (range, 4-60 months). All 4 rectus muscles were identified in 93 patients, 3 recti were identified in 6 patients, and 2 recti were identified in 1 patient. In 2 patients, the levator muscle mistakenly was thought to be the superior rectus muscle and was connected to the implant. Reconstructive surgical procedures were required in both cases. At final follow-up, 98% of patients believed that they had benefited from surgery, with an improved prosthetic appearance, improved symmetry between the 2 eyes, improved comfort, better prosthetic motility, or a combination thereof. Compared with the results of the preoperative examination, implant and prosthetic motility was improved in 92% to 98% of patients.
  
  
  CONCLUSIONS
  The tunnel technique allows successful localization of extraocular muscles during secondary orbital implant surgery in a high percentage of patients. Surgical outcomes were excellent, with few complications and high patient satisfaction.
authors.affiliation: University of Ottawa Eye Institute, Ottawa, Canada.
authors.forename: David R
authors.initials: DR
authors.lastname: Jordan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000853:Anophthalmos / Q000534:rehabilitation; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000000981:diagnostic imaging / Q000601:surgery*; D020273:Orbital Implants; D019919:Prosthesis Implantation / Q000379:methods*; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed