title: Osseointegrated implants for orbito-facial prostheses: Preoperative planning tips and intraoperative pearls.
abstract: OBJECTIVE
  Implant-retained facial prostheses are becoming increasingly sophisticated. We describe our experience with successful implant placement.
  
  
  METHODS
  Retrospective case series. Patients with severe unilateral orbital deformity who underwent socket reconstruction with placement of orbital implants were identified. Data on patient age, gender, mechanism of eye, soft tissue, and bone loss, prior reconstructive surgeries and radiation, and orbital imaging were collected and analyzed.
  
  
  RESULTS
  Four patients (9 implants) between 2010 and 2014, who had osseointegrated implants placed for orbito-facial prostheses were identified. Three were male, one female. Average age was 59 years (range 34-86). Reason for eye loss was trauma in two patients, exenteration for recurrent rhabdomyosarcoma in one patient, and enucleation for retinoblastoma in one patient. All patients had Vistafix® (Gothenburg, Sweden) osseointegrated titanium implants (4 mm) placed in a 2-stage procedure over a span of 3-6 months with subsequent successful prosthesis fitting.
  
  
  CONCLUSIONS
  Implant-retained orbito-facial prostheses are safe, easy, and reliable. The ideal socket has minimal dead space, robust bone, and soft tissue 4-5 mm in depth. Preoperative planning should consist of: 1) orbit CT; 2) careful clinical exam of the orbital deformity; and, 3) analysis of socket topography. Operative tips for successful implant placement include: 1) 2-3 points of fixation; 2) placement of implants in bone of adequate thickness; and 3) implant placement as a 2-stage rather than 1-stage procedure. There appears to be no difference in outcome in irradiated and non-irradiated sockets in this series, but should be a consideration and discussed with the patient.
authors.affiliation: a Department of Ophthalmology, Oculoplastic, Facial Cosmetic and Orbital Surgery Service , University of Wisconsin-Madison , Madison , Wisconsin , USA.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Wei
authors.affiliation: b Medical Art Resources, Inc ., Milwaukee , Wisconsin , USA.
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Brown
authors.affiliation: c Global Prosthetics, Inc ., Madison , Wisconsin , USA.
authors.forename: Dori K
authors.initials: DK
authors.lastname: Hosek
authors.affiliation: a Department of Ophthalmology, Oculoplastic, Facial Cosmetic and Orbital Surgery Service , University of Wisconsin-Madison , Madison , Wisconsin , USA.
authors.forename: Cat N
authors.initials: CN
authors.lastname: Burkat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015353:Eye Enucleation; D005137:Eye, Artificial; D005147:Facial Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000000981:diagnostic imaging / Q000601:surgery*; D020273:Orbital Implants; D016348:Osseointegration / Q000502:physiology*; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D014025:Titanium; D014057:Tomography, X-Ray Computed
chemical_list: D014025:Titanium
keywords: Orbitofacial prosthesis; orbital deformity; osseointegrated implant