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Bioelectronic implants featuring soft mechanics, excellent biocompatibility, and outstanding electrical performance hold promising potential to revolutionize implantable technology. These biomedical implants can record electrophysiological signals and execute direct therapeutic interventions within internal organs, offering transformative potential in the diagnosis, monitoring, and treatment of various pathological conditions. However, challenges remain in improving excessive impedance at the bioelectronic-tissue interface and thus the efficacy of electrophysiological signaling and intervention. Here, we devise orbit symmetry breaking in MXene (a low-cost scalability, biocompatible, and conductive two dimensionally layered material, which we refer to as OBXene), which exhibits low bioelectronic-tissue impedance, originating from the out-of-plane charge transfer. Furthermore, the Schottky-induced piezoelectricity stemming from the asymmetric orbital configuration of OBXene facilitates interlayered charge transport in the device. We report an OBXene-based cardiac patch applied on the left ventricular epicardium of both rodent and porcine models to enable spatiotemporal epicardium mapping and pacing while coupling the wireless and battery-free operation for long-term real-time recording and closed-loop stimulation.

The surgical treatment of maxillary tumours often consists of an open subtotal or total maxillectomy with a subsequent significant defect. Reconstruction is, therefore, a major challenge for head and neck surgeons. Along with 3D printing development, titanium pre-bent implants have been created for orbital wall and floor reconstruction. The aim of this study was to evaluate the post-operative tolerance of these implants in patients who had undergone this procedure in our department. Implant tolerance was the primary endpoint, evaluated by whether or not surgery was required for infection or extrusion 6 months after the procedure. The secondary endpoints were satisfactory functional and aesthetic characteristics of the reconstruction as well as the quality of life. Eleven patients underwent a maxillectomy with orbital floor resection for tumours and reconstruction using the titanium PorousiTi® (Materialise®, Leuven, Belgium) implant beginning in 2013 in Lariboisière Hospital, Paris. The mean follow-up time was 17 months (range, 6-34). During the follow-up period, two patients (n = 2/11; 18.2%) were operated again for implant extrusion and exposure through the skin 1 month later or during their radiotherapy course. During the follow-up period, no post-operative infection occurred in any of the patients. In our experience, the implant was well-tolerated with few post-operative complications and satisfactory aesthetic and functional results., Competing Interests: Declaration of Competing Interest None., (Copyright © 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Pedicled buccal fat flaps have demonstrated great utility for oral reconstructions. We present a retrospective case description detailing the utility of the buccal fat pad (BFP) as an anterior maxillary flap for midfacial and lower eyelid volumization and reconstruction. A 64-year-old healthy female had undergone bilateral lower blepharoplasty with silicone tear tough implantation, complicated by infection of the right tear trough implant. Delayed implant removal resulted in chronic infection and inflammation producing significant right lower eyelid retraction, and full-thickness scarring to the orbital rim. Reconstruction was performed, featuring the creation of a midfacial subperiosteal pocket and to access the BFP, which was mobilized and secured to the inferior orbital rim. Long-term follow-up confirms ongoing viability of the surgical intervention. Herein, the BFP is shown to be a source of vascularized volume in reconstructive periorbital surgery.

Fibrous dysplasia is a benign tumor of the skeleton. Mostly 2 forms are described: a monostotic and a poliostotic form. The maxilla and the mandible are the most interested of the facial district. The authors report a patient of a huge maxillary fibrous dysplasia. A 63-year-old patient was treated for a 20-year progressive left maxillary neoformation. A total maxillectomy was performed. The defect was reconstructed with a custom-made midface implant associated with a temporal and a pericranial flap.

The aim of this study was to investigate whether a method of designing digital models of facial prostheses was suitable for patients with orbital defects. 32 patients were included in a retrospective study. 23 of them already had a facial prosthesis. 3D-data of the faces were acquired optically using fringe projection technique without and with (if available) the facial prosthesis in place. The healthy side of the surface models was mirrored to reconstruct the defect area. By generating a NURBS-model, the edges of the virtual prostheses were adapted to the defect region. The CAD models were stored in STL format as templates for facial prostheses. Using an automatically calculated asymmetry index (AI), four situations of the digitized facial surface were analysed for symmetry: 1. with defect area excluded, 2. with mirrored healthy surface, 3. with digital CAD template, and 4. with manually produced facial prosthesis inserted (if available). Mean AI values were 6.05 ± 3.26 (situation 1), 4.79 ± 2.51 (situation 2), 5.12 ± 2.61 (situation), and 6.74 ± 2.77 (situation 4). Additionally, the CAD templates were rated by three anaplastologists. Ratings did not differ significantly. They partially agreed with the three statements "The CAD prosthesis fits harmoniously within the face", "The CAD prosthesis could be used for a wax pattern during conventional fabrication" and "The CAD prosthesis and the wax pattern reduce workload". The results indicate that the presented technique has the potential to increase facial symmetry and facilitate the technical procedure. However, symmetry alone is not a sufficient criterion for design of a facial prosthesis., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: The management of fronto-orbital fibrous dysplasia involves total excision of the dysplastic bone and bone reconstruction using implants. Custom-made implants are used to achieve good contouring. However, the remnant defect after excising the lesion often does not match the implant., Methods: To design the craniotomy line, a template was prepared by preoperative computed surgical simulation. The template was overlaid on the preoperative cranium, such that its inner surface fits exactly with the cranial surface. After excising the lesion by performing osteotomy, the implant was placed in the defect and fixed. Both template and implant were made of hydroxyapatite., Results: The authors treated 4 patients, with fibrous dysplasia involving the fronto-facial region by using the template. Intraoperative trimming of the implant or bone defect was not required in 2 patients, while the third patient required mild trimming. They did not have any complications and obtained good contouring., Conclusion: The hydroxyapatite templates reduced the surgical time by determining the precise craniotomy line preoperatively, thus avoiding needless trimming of the implant and bone defect. Therefore, they can enhance the efficacy of treatment for fronto-orbital fibrous dysplasia lesion.

Introduction: The purpose of our study was to describe a novel technique for reconstruction of orbital defects after maxillectomy using a non-anatomic titanium mesh suspension of orbital contents for both support and volume correction. This construct is then articulated with a layered fibula osteocutaneous free flap that restores orbital rim, zygoma, and maxillary alveolus. We herein present our application of this technique, including refinements over time and long-term outcomes., Methods: A retrospective review was performed on 12 patients who underwent reconstruction of Brown class III orbitopalatomaxillary defects with extensive orbital involvement (at minimum complete orbital floor and rim absent) with titanium mesh sling and a layered fibula free flap., Results: Primary reconstruction was accomplished in all 12 patients. The mean postoperative length of stay was 8 days (6-14 days). There were no free flap failures or perioperative re-explorations. Patients were routinely extubated on postoperative day #1 and began oral intake by postoperative day #3. At a mean follow-up length of 48 months, unrestricted eye function was accomplished in all patients. Midfacial symmetry was accomplished in 10 of 12 patients; 2 patients had moderate asymmetry due to extirpation of facial musculature and/or soft tissue. Minor revisions were necessary for lower lid ectropion and exposure of the titanium plate. Two patients required adipofascial free flap coverage of exposed intraoral bone after radiation therapy., Conclusions: This technique provides excellent restoration of eye position and function and also allows for implant-based prosthetic rehabilitation. It has become our procedure of choice for orbitomaxillary reconstruction., (© 2017 Wiley Periodicals, Inc.)

To evaluate the clinical results of reconstruction orbital defect with craniomaxillofacial implant. Three patients with orbital defect were treated with ten implants. The magnetic abutments were attached six months after one stage operation and the prostheses were fabricated. Within 11 to 47 months of follow up, all implants were stable with successful osseointegration. The prosthesis fit the orbital defects well. Reconstruction of orbital defect with craniomaxillofacial implant can be considered as a viable alternative treatment.

The aim of the study was to assess the mid-term effectiveness and safety of an original technique consisting of reconstructing fractures of the medial wall of the orbit with porous polyethylene implants with an exclusive transnasal approach. Twenty-five patients were treated. Each patient underwent a pre-operative ophthalmologic evaluation and a CT scan. The surgery started with an anteroposterior ethmoidectomy of the fractured side; all the fractured bone fragments were removed and all usual landmarks of healthy bony margins were identified. A Medpor sheet was placed endoscopically to reconstruct the fractured wall. Each patient received an immediate postoperative CT scan, and was evaluated at day 1, 7, 30 and 6 months after surgery clinically and with an endoscopic examination. In all patients, preoperative enophthalmos and/or diplopia were corrected. The CT scans showed excellent reconstruction of the fractured bony walls. The immediate postoperative period was characterized by a very high degree of subjective comfort. No perioperative complications were detected. At the 6 months follow up, all meshes appeared covered by epithelialized mucosa at the endoscopic inspection, and clinical results were stable. Scars or lid complications are always prevented. The technique described has become the standard to treat medial wall fractures in our department., (Copyright © 2017. Published by Elsevier Ltd.)

Purpose: One of the key challenges during orbital fracture reconstructive surgery, due to the complex anatomy of the orbit, is shaping and trimming the precise contour of the implants. The objectives of this study were to describe and evaluate the use of a three-dimensional (3-D) printing technique for personalized reconstructive surgery for repairing orbital fractures., Methods: A total of 29 cases which had 3-D technique-assisted surgical reconstruction, and 27 cases which had traditional surgery, were retrospectively analyzed. Preoperative and postoperative CT images were measured using MIMICS software, and the contour of the fracture zone and the Medpor-titanium implant were analyzed and compared. The surgical duration was also compared between the two groups., Results: There were statistically significant differences in the maximum width, depth and area between fracture zone and implant between the two groups, with the absolute value in the 3-D group markedly lower as compared to the control group. In addition, the difference in the medial-inferior wall angle between the surgical eye and healthy eye was also statistically significant between the groups. The average surgical duration in the 3-D group was substantially shorter than in the control group. Additionally, the postoperative clinical evaluation in the 3-D group was superior to that of the control group., Conclusion: The 3-D printing technique is of great value for predicting the precise fracture zone before, and during, personalized surgery, and can help surgeons achieve accurate anatomical reconstruction for repairs of blowout orbital fractures. Moreover, the simulated bone template produced by 3-D printing models allows for "true-to-original" orbital reconstruction, which can shorten the surgical duration and improve the accuracy and safety of the operation.

Objective: The aim of the study was to precisely assess the severity of traumatic orbital defects and techniques for personalized orbital reconstruction., Methods: A retrospective study was conducted in 97 patients with traumatic orbital defects who were treated in our hospital between July 2003 and June 2012. Pre- and postoperative spiral computed tomography scans were performed in all patients. A spatial orientation technique was used to measure the three-dimensional position of the globe and calculate the changes in the orbital volume. Subsequently, a computer-assisted technique and a rapid prototyping technique were used to create a personalized orbital model to aid in the planning of surgery as well as the preforming of implants and bone plates. During surgery, the herniated orbital contents were returned; the preformed titanium mesh, Medpor, or other implants were placed; the orbital shape in the defect site was precisely restored; and normal proportions between the orbital walls and orbital contents were regained. The treatment outcomes were evaluated with respect to postoperative appearance, patients' satisfaction, ophthalmologic examination, and computed tomography scan. The complications were analyzed accordingly., Results: Satisfactory results were achieved in all patients with the following exceptions: 1 patient with an unsatisfactory facial appearance; 2 patients with old trauma and an unfavorable correction of enophthalmos who experienced diplopia with no significant improvement within 6 months after surgery; and 2 patients of mild postoperative lower eyelid ectropion. All other patients achieved satisfactory treatment effects, that is, the orbital shape in the defect site was precisely restored, and normal proportions between the orbital walls and orbital contents were regained. There were no other severe complications reported., Conclusions: In patients with traumatic orbital defects, accurate digital evaluations of the three-dimensional position of the globe and changes in the orbital volume aid in surgical planning with a personalized model and promote early surgery with minimal trauma. When the orbital volume was restored and the position of the globe was maintained or corrected, the precise reconstruction of the anatomic shape of the orbit was concurrently completed. Personalized orbital reconstruction can improve the efficacy of plastic surgery in patients with orbital deformities.

The aim of this study was to compare the effectiveness of porous polyethylene, titanium mesh, and castor oil-derived biopolymer randomized in orbital reconstructions of defects larger than 1 cm in length on the inferior and medial walls. A total of 63 patients (64 orbits) were evaluated to determine the presence of diplopia, enophthalmos ocular motility, and infraorbital nerve paraesthesia in both the preoperative and postoperative periods. The surgeons' opinions of the ease in handling the implants were also obtained after each procedure. The patients were divided into 3 groups: 17 received porous polyethylene, 21 received castor oil-derived biopolymer, and 26 received titanium mesh. In the preoperative period, 30 patients experienced enophthalmos, 11 experienced diplopia, and 12 experienced ocular motility. Ninety days after the orbital reconstruction, 6 cases of enophthalmos persisted, as did 2 cases of diplopia and 2 cases of ocular motility. Ten patients developed some type of postoperative complication. Material removal was required in only 1 case. Regardless of the size of the defect, the materials used were found to be effective for reconstructing orbital volume; they were also found to offer ease in handling and stabilization., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Enophthalmos after a ventriculo-peritoneal (V-P) shunt placement is very rare. Previous defects of the orbital wall with intracranial hypotension can cause enophthalmos after V-P shunting. The authors present 2 patients of enophthalmos with orbital wall defects resulting from anterior clinoidectomy that was performed during previous aneurysmal surgery. Both patients received a V-P shunt for hydrocephalus after subarachnoid hemorrhage. Although the hydrocephalus was improved by V-P shunts in both patients, sunken eyes were observed. The patients received reconstructive surgery of the superior orbital wall using titanium mesh and recovered after surgery without any neurological deficits. Here, the authors present 2 patients of enophthalmos with orbital wall defects treated by orbital wall reconstruction., Competing Interests: The authors report no conflicts of interest.

Introduction: In orbital reconstruction, the optimal location of a predefined implant can be planned preoperatively. Surgical results can be assessed intraoperatively or postoperatively. A novel method for quantifying orbital implant position is introduced. The method measures predictability of implant placement: transformation parameters between planned and resulting implant position are quantified., Methods: The method was tested on 3 human specimen heads. Computed Tomography scans were acquired at baseline with intact orbits (t0), after creation of the defect (t1) and postoperatively after reconstruction of the defect using a preformed implant (t2). Prior to reconstruction, the optimal implant position was planned on the t0 and t1 scans. Postoperatively, the planned and realized implant position were compared. The t0 and t2 scans were fused using iPlan software and the resulting implant was segmented in the fused t2 scan. An implant reference frame was created (Orbital Implant Positioning Frame); the planned implant was transformed to the reference position using an Iterative Closest Point approach. The segmentation of the resulting implant was also registered on the reference position, yielding rotational (pitch, yaw, roll) as well as translational parameters of implant position., Results: Measurement with the Orbital Implant Positioning Frame proved feasible on all three specimen. The positional outcome provided more thorough and accurate insight in resulting implant position than could be gathered from distance measurements alone. Observer-related errors were abolished from the process, since the method is largely automatic., Conclusion: A novel method of quantifying surgical outcome in orbital reconstructive surgery was presented. The presented Orbital Implant Positioning Frame assessed all parameters involved in implant displacement. The method proved to be viable on three human specimen heads. Clinically, the method could provide direct feedback intraoperatively and could improve postoperative evaluation of orbital reconstructive surgery.

We present a rare case of a 3-year-old boy with an odontogenic myxoma (OM) involving the orbita. Including our case, only nine cases of OM have been reported to involve the eye in children.There is no gold standard for treatment of OM in children with orbital involvement. The recurrence rate of OM in children seems low, which advocates for less invasive surgery. A gentle resection of the OM was carried out. The floor and medial wall of the orbit was reconstructed immediately using a non-resorbable Medpor implant with passive adaptation. Reconstruction with a Medpor implant in children has rarely been reported in the literature. No clinical or radiological recurrence was observed 24 months after surgical removal, and the patient presented with symmetric appearance and normal vision., (2016 BMJ Publishing Group Ltd.)

Facial prostheses are generally fabricated from silicones, which provide life-like appearance and flexibility. The longevity of silicone, however, is limited because of its tendency to support fungal growth, absorb oils and grease, and edge-tearing susceptibility. Polyurethane (PU) liners have been used on the tissue-bearing surface of such prosthesis to improve tear resistance and fungal resistance. Technique sensitivity, discoloration and metamerism are significant limitations of urethane lining. Further, this liner is incorporated during processing of definitive prosthesis, which precludes try-in of tissue surface of prosthesis. This article describes an alternative lining material for fitting surface of definitive orbital prostheses, which could overcome limitations associated with all silicone or PU lined silicone prostheses.

Fracture of the orbital floor is commonly seen in facial trauma. Accurate anatomical reconstruction of the orbital floor contour is challenging. The authors demonstrate a novel method to more precisely reconstruct the orbital floor on a 50-year-old female who sustained an orbital floor fracture following a fall. Results of the reconstruction show excellent reapproximation of the native orbital floor contour and complete resolution of her enopthalmos and facial asymmetry.

Optimum functional and aesthetic facial reconstruction is still a challenge in patients who suffer from inborn or acquired facial deformity. It is known that functional and aesthetic impairment can result in significant psychosocial strain, leading to the social isolation of patients who are affected by major facial deformities. Microvascular techniques and increasing experience in facial transplantation certainly contribute to better restorative outcomes. However, these technologies also have some drawbacks, limitations and unsolved problems. Extensive facial defects which include several aesthetic units and dentition can be restored by combining dental prostheses and anaplastology, thus providing an adequate functional and aesthetic outcome in selected patients without the drawbacks of major surgical procedures. Referring to some representative patient cases, it is shown how extreme facial disfigurement after oncological surgery can be palliated by combining intraoral dentures with extraoral facial prostheses using individualized treatment and without the need for major reconstructive surgery., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Lower blepharoplasty is a cornerstone in facial rejuvenation and improvement. Despite its popularity, several adverse effects have been described; of these, postsurgical eyelid displacement, with its aesthetic and functional consequences, is one of the more frequent complications. The tarsal sling procedure is a simplified canthopexy consisting in the fixation of the lateral portion of the septum--the canthal ligament--to the orbital wall periosteum. The aim of the current research is to demonstrate how the tarsal sling technique is effective in the prevention of lower lid malpositioning. A retrospective analysis of 40 consecutive healthy individuals was carried out. In group 1, 20 patients underwent standard blepharoplasty; in group 2, blepharoplasty was associated to the tarsal sling canthopexy. Pre- and postsurgical position of the lower eyelid margin was compared through photographic measurements at 5 time points and statistical analysis performed. Group 1 patients evidenced an increased distance between the interpupillary line and the lateral aspect of the lower lid margin. A progressive spontaneous improvement (reduction in scleral exposition) was detected. Patients who underwent the tarsal sling procedure (group 2) reported a postoperative overcorrection of scleral appearance. Two years postsurgery, progressive relapse occurred, but the lower eyelid did not reach presurgical values and maintained a slight degree of overcorrection. Tarsal sling is an easy, fast, and efficacious procedure to prevent eyelid displacement in lower blepharoplasty. Its routine use is a tool to assure further support to lower lids in the younger patients or when lid laxity is absent during presurgical examination.

Aim: Diagnosis and treatment of tumors of the eye is extremely difficul; surgical treatment in advanced stages, when the tumor grows in the orbit, leads to extensive radical surgery of the face. The extent and nature of surgical procedures depends on the nature of the tumor process, in advanced stages is indicated mutilating surgery--exenteration of the orbit. Exenteration of the orbit due to the extrascleral extension of malignant melanoma of the uvea is very rare, unfortunately, even today in certain cases it is necessary to make such a mutilating surgery., Materials and Methods: Case report--65 year old female patient, sent to our Departement in 2008 with the finding of the pigment deposits on the posterior pole of the left eye. Ultrasound study found elevations of up to 3 mm, she was asked to come for further control in three months interval. She did not coma, furthermore she sporadically attended another eye clinic. In 2011 she was treated for secondary glaucoma--cyclocryopexia. Due to pain another surgery--tarzoraphia was indicated. In 2012 she underwent surgery at St. Elisabeth Cancer Institute in Bratislava--Nefrectomia transperitoneally l. dx., excision hepatis. Histological examination in addition to the primary papillary renal carcinoma--mucinous tubular T1 Nx Mx type, found the metastasis of malignant melanoma to the liver and right kidney. She underwent the diagnostic procedure to find the origo of the melanoma. The patient was subsequently admitted to our clinic with blind painfull eye for enucleation. During the surgery the was found retrobulbar tumor ingrowth. Histopatholigical findings confirmed malignant melanoma. Indicated was exenteration of the orbit due to malignant melanoma T4 N0 M2 stage in June 2012. After healing of the cavity she was recommended to design an individual prosthesis. After completing several courses of palliative chemotherapy during a recent review in January 2015 the patient is without recurrence of the melanoma in the orbit, Results: Histological examination confirmed malignant melanoma in stage G2, predominantly epithelioid type, spindle cell type in part B of pips, tumor fills the entire back and part of the anterior chamber, grows through the sclera and optic nerve is completely overgrown by tumor mass and spreads into orbit. The immunophenotype is suggesting a better prognosis (S100+, melanoma+, +HMB45, cyklin D1 3%, 10% of p53, Ki67 3%). Tissue eyelashes were infiltrated by numerous micrometastases. The patient after exenteration of the orbit after 3 months got an individual epithesis. Local orbit cavity is more than 24 months after exenteration without recurrence of melanoma. The patient is still undergoing outpatient chemotherapy and feels good., Conclusion: The treatment of malignant tumors of the orbit and the eye is difficult, in most cases surgical treatment is indicated, with the additional radiation therapy and chemotherapy. Malignant tumors at an advanced stage should to be solved radically. Exenteration of the orbit leads to produce a large defect in the orbit and this part of the face. Patients in the active age after surgery followed by facial defects after such procedures have disadvantage in work and thie defect leads to serious socio-economic challenges. Patients with individually made prosthesis comprising a refund of the eyeball and the surrounding soft tissues allow active life and full application of the private as well as professional life.

Purpose: Preformed orbital titanium meshes have been introduced to improve outcomes in the treatment of orbital wall fractures. This study evaluated the geometry of different commercially available orbital meshes and compared them with an average human orbit., Materials and Methods: Seven commercially available preformed orbital meshes were scanned using an optical scanner. For comparison, an average orbit was generated from 113 computed tomographic scans of unaffected orbits. Meshes and the average orbit were compared by registration and the calculation of congruence., Results: All meshes showed a high similarity within a ±1.5-mm deviation corridor. Major differences were seen in the slope between the orbital floor and the medial wall and in the upturning toward the lateral orbital rim., Conclusion: Preformed orbital meshes conform highly to an average orbit, but differ in size and geometry. Using special software, the best fitting mesh could be chosen preoperatively to improve surgical outcome if its geometry were published., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background and Aim: Leaving open or closing the oculo-facial defect by means of a myocutaneous flap mainly depends on maxillofacial surgical considerations. For those cases that present a closed defect, the authors aim to evaluate an innovative method of ocular bulb positioning using a magnetic resonance imaging dataset., Technique: Following cancer removal and plastic reconstructive surgery, a Digital Imaging and Communications in Medicine format magnetic resonance imaging dataset was used to determine the volume and position of the left ocular bulb. The exact location of the prosthetic bulb was determined by mirroring this position on the affected side. Images of the eyeglasses were imported into the virtual environment, and the designs of the substructure and facial prosthesis were projected using computer-aided design/computer-aided manufacture (CAD/CAM) technology., Discussion: The updated method presented here enables restoration with a facial prosthesis, even when a myocutaneous flap is used to close the defect, thereby resolving the problem of ocular bulb positioning and enabling the rapid and easy design of a retention system connected to eyeglasses., Clinical Relevance: The proposed protocol aims to develop and describe a viable method for the construction of a facial prosthesis for a patient whose face had been reconstructed using a myocutaneous free flap., (© The International Society for Prosthetics and Orthotics 2013.)

Defects of orbital walls can be reconstructed using implants. The authors report a safe and accurate method to reconstruct bone defects in the orbital area using patient specific implants. A detailed process description of computer aided design (CAD) reconstructive surgery (CRS) is introduced in this prospective study. The 3D volumetric virtual implant was design using MSCT data and PTCProEngineer™ 3D software. The intact orbital cavity of twelve patients was mirrored to the injured side. Specific ledges steered the implant into correct place. Postoperatively the position was assessed using image fusion. One implant (8%) was rejected due to chemical impurities, two (16%) had a false shape due to incorrect CAD. Data of thin bone did not transfer correctly to CAD and resulted in error. One implant (8%) was placed incorrectly. Duration of the CRS was in average 1.17 h, correspondingly 1.57 h using intraoperative bending technique. The CRS process has several critical stages, which are related to converting data and to incompatibility between software. The CRS process has several steps that need further studies. The data of thin bone may be lost and disturb an otherwise very precise technique. The risk of incorporating impurities into the implant must be carefully controlled., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: Reconstruction of large craniofacial defects has largely improved since custom-made implants have been developed in the past decade. For large lesions in fronto-orbital region (such as osteomeningioma), we applied a simple and reliable protocol to perform optimal primary reconstruction with PEEK (polyetheretherketone) specific implant at the same time of the resection., Material and Methods: Our protocol is based on virtual preoperative surgery with a planned bone resection that allows engineering of a specific implant to accurately fit to the defect during the surgery. Thus tumour removal and optimal immediate reconstruction are performed easily in a single-step procedure. The use of navigation is required to perform accurate resection according to the planning. We report our experience in five patients requiring complex orbito-frontal reconstruction., Results: Planned resection was always achieved with accurate placement of the implant. Optimal orbital reconstruction is allowed and permits exophthalmos correction and orbital contour symmetry. No major complication was observed., Conclusion: We provide a simple one-step technique to reconstruct the orbit while achieving symmetric cosmetic and functional results, reducing operative time and avoiding donor site morbidity., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Unlabelled: Predictable and stable functional and aesthetic result is the aim of priority for the neurosurgeon dealing with the reconstruction of large cranial bone defects and complex-formed skull defects involving cranio-orbital region., Aim: the paper presents the experience with САD/САМ titanium and polyetheretherketone (PEEK) implants for complex-formed and large skull bone defects reconstruction., Material and Methods: Between 2005 and 2013 nine patients (5 females and 4 males) underwent cranioplasty and cranio-facial reconstruction with insertion of the customized САD/САМ titanium and PEEK implants. Computer-assisted preoperative planning was undertaken by the surgeon and the engineer together in 3 cases to provide accurate implant design. Eight patients had complex-formed and large posttraumatic defects of fronto-orbital (7 cases) and parietal (one case) regions. In two of these cases one-step reconstruction surgery for posttraumatic fronto-orbital defects combined with adjacent orbital roof (one case) and orbito-zygomatic (one case) deformities was performed. One patient underwent one-step primary cranioplasty after cranio-orbital fibrous dysplasia focus resection. Titanium implants were used in 4 cases while PEEK implants - in 5 ones. The follow-up period ranged from 6 months till 8,5 years (median 4,4 years)., Results: The accuracy of the implant intraoperative fit was perfect in all cases. Postoperative wounds healed primary and there were no any complications in the series presented. Post-op clinical assessment and CT data testified to high implants precision, good functional and aesthetic outcomes in all patients., Conclusion: САD/САМ titanium and PEEK implants application should allow for optimal reconstruction in the challenging patients with complex-formed and large skull bone defects providing predictable good functional and aesthetic result together with surgery morbidity and duration reduction. Computer-assisted preoperative planning should be undertaken for САD/САМ implants creation in the cases of posttraumatic defects combined with adjacent bone structures deformities and benign bone tumors of cranio-orbital region, thus enabling one-step reconstructive surgery resulted in essential symmetry attained.

Introduction: Meningiomas of the fronto-basal skull are difficult to manage as the treatment usually includes extensive resection of the lesion, consecutive reconstruction of the meninges and of the skull. Especially after removal of spheno-orbital and sphenoid-wing meningiomas, the cosmetic result is of utmost importance. In this technical note, we present our institutional approach in the treatment of skull base meningiomas, focussing on the reconstruction of the neurocranium with individually preformed titanium cranioplasty (CRANIOTOP(®), CL Instruments, Germany)., Case Report: Two female patients (40 years, 64 years) are presented. Both patients presented with skull base lesions suggestive of meningiomas. The preoperative thin-sliced CT scan was processed to generate a 3D-model of the skull. On it, the resection was mapped and following a simulated resection, the cranioplasty was manufactured. Intra-operatively, the titanium plate served as a template for the skull resection and was implanted after microsurgical tumour removal, consecutively. The cosmetic result was excellent. Immediate postoperative CT scan revealed accurate fitting and complete tumour removal. Control Magnetic Resonance Imaging (MRI) within 12 weeks was possible without any artifacts., Discussion: The comprehensive approach described indicates only one surgical procedure for tumour removal and for reconstruction of the skull. The titanium plate served as an exact template for complete resection of the osseous parts of the tumour. Cosmetic outcome was excellent and control MRI was possible post operatively., Conclusion: CRANIOTOP(®) cranioplasty is a safe and practical tool for reconstruction of the skull after meningioma surgery., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Treatment of orbital floor fracture is a subject of great interest in maxillofacial surgery. Many materials have been described for its reconstruction.In this article, the authors report a case of a patient who, 7 years from a previous orbital floor fracture and treatment with silastic sheet, presented herself to their clinic for the failure of the material used for its reconstruction and a skin fistula.Orbital floor repair with silastic sheet is an old method that no one uses anymore, but we still observe cases of late complications with this material. So a fine knowledge of silastic sheet complications is needed for young surgeons.The authors report the case and perform a literature review about the use of more modern biomaterials for orbital floor reconstruction.

Introduction: Reconstructions of the fronto-orbital area remain a challenge to the reconstructive surgeon, due to the functional and esthetic impact., Observation: The authors present a case of a complex fronto-orbital reconstruction with a PEEK (PolyEtherEtherKetone) implant, associated with a skin expansion., Discussion: With a follow-up of over three years, the cosmetic result is excellent. The authors believe that this technique is reliable, fast with long-term good results., (Copyright © 2012. Published by Elsevier Masson SAS.)

Introduction: Optimizing the ocular surface and achieving acceptable cosmesis are important considerations in the rehabilitation of patients with keratoprosthesis (KPro). In osteo-odonto-KPro and type 1 Boston KPro surgery, it is important to ensure a healthy ocular surface to increase the chance of functional success., Materials and Methods: The authors present 2 patients with KPros undergoing orbital decompression surgery. This series highlights a novel indication for orbital decompression surgery for patients, who are usually 1-eyed, undergoing KPro surgery. It illustrates the importance of globe position to either optimize the ocular surface or allow a cosmetic shell to be worn. To the authors' knowledge, such indications for orbital decompression have not been reported to date., Results: Two-wall and intraconal fat orbital decompression surgery achieved globe retroplacement of 6 mm and 7 mm, allowing fitting of a cosmetic shell over the osteo-odonto-KPro and reducing lagophthalmos and corneal exposure in patients 1 and 2, respectively., Conclusion: Indications for orbital decompression exist in patients undergoing osteo-odonto-KPro or KPro to reduce pseudoproptosis or exposure.

It is challenging to treat and irradiate empty cavities with external-beam radiation therapy (EBRT) because body contour irregularities can result in dose heterogeneities. The use of compensator materials to fill the empty cavities can provide a more homogeneous radiation dose distribution. The purposes of this clinical report are to describe the use of 3 different materials (elastomeric material, water-filled balloon, and acrylic resin) in an orbital defect and compare the dosimetric parameters and photon-electron dose distribution during EBRT., (Copyright © 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Treatment of facial trauma sequelae is a complex and challenging process. There is still controversy over suitable materials for orbital wall reconstruction. This study evaluated calcium phosphate cement (CPC) implants manufactured by rapid prototyping in the repair of orbital wall defects secondary to trauma. Computed tomographic scans of 5 patients were used for surgery planning and production of CPC implants. Implants were used to restore orbital wall anatomy, ocular alignment, and facial contour. Benefits resulting from the use of implants, such as a reduced operating time, patient response to biomaterial implantation, biomaterial integrity and stability, and patient satisfaction with treatment, were analyzed qualitatively. Our results suggest that CPC is an effective and safe material for orbital reconstruction because of its biocompatibility and easy production and placement.

Skeletal deformity in the fronto-orbital region resulting from various problems can have significant aesthetic concerns. Restoring an aesthetically acceptable appearance relies most importantly on the restoration of a precise skeletal contour. Current surgical options for depression deformities or partial-thickness defects range from extensive corrective osteotomies to less complicated methods of onlay grafting with autogenous or alloplastic materials. Both methods have difficulties in providing a symmetric and smooth contour for predictable and reliable cosmetic results. Alloplastic implants provide another effective alternative and the success of the skeletal contouring correlates directly with the accuracy of the implant sculpture. Prefabricated methylmethacrylate implants, with the aid of modeling clay, computer imaging, and modern rapid-prototyping technologies, fits the depression deformity well and balances the skeletal contour. It provides plastic surgeons greater precision in customizing the implant, which ensures better predictability and reliability of cosmetic outcomes.

The repair of fronto-orbital nasal bone defects may be a troublesome problem to plastic surgeons. This report aims to present the results of reconstruction of fronto-orbital nasal bone defects with the prefabrication of epoxied maleic acrylate/hydroxyapatite compound (EH compound) using 3-dimensional (3D) imaging data and computer-assisted manufacturing techniques, sometimes combined with autogenous bone to repair nasal defect. Helical computed tomography data were used to create a 3D model of the patient's skull. On the basis of these data, the individual shape of the implant was created by a computer-aided design/computer-aided manufacturing program. A rapid prototyping system was applied for production of the physical models. A total of 12 patients with traumatic fronto-orbital nasal defects were included in this study. The patients followed up for 1 to 24 months. The satisfactory results, such as excellent symmetry, stability, and normal fronto-orbital contours were obtained for all patients. The operating time was short without any complications. The depression of the region of fronto-orbital nasal bone defects always achieved an attractive or satisfactory prominence that was in balance and harmony with other facial features of all the patients. This method allows accurate fabrication of the implant. It improves the surgical techniques and reduces the risk of a second intervention, with improved aesthetic outcomes.

Amniotic membrane grafts are used extensively for ocular surface reconstruction. We describe the case of a 66-year-old man with traumatic, restrictive strabismus. Amniotic membrane was applied to resolve symblepharon between the globe and lids and also to prevent re-formation of adhesions between extraocular muscles and adjacent titanium plates placed during prior surgery., (Copyright © 2011 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

Purpose: A normally restored orbital structure after reconstructive surgery would accelerate the return of orbital function. The aim of the present study was to compare the outcomes of 2 orbital implants: autogenous grafts and porous polyethylene (Medpor)., Materials and Methods: A longitudinal study was conducted of all patients who had undergone orbital floor reconstruction using an autogenous graft or Medpor. The study participants were divided into 2 groups, and the postoperative outcomes were assessed clinically., Results: Of the 26 patients, 14 (53.0%) had undergone surgery with an autogenous graft and 12 (46.2%) with Medpor. Postoperatively, no diplopia in the primary gaze was noted in any patient. However, down gaze and peripheral diplopia was found in 11.5% and 26.9% in the autogenous group and in 3.8% and 26.9% in the Medpor group, respectively (P = 1.24). Enophthalmos was present in 11.4% of the autogenous graft group and 15.3% of the Medpor group (P = .465). The Hess chart findings were abnormal in 11.4% of both groups (P = .062). Restriction of movement was observed in 1 patient (3.8%) from the autogenous group and 7.7% of the Medpor group (P = .574)., Conclusions: Orbital floor reconstruction using an autogenous graft or Medpor showed comparable results., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Extraoral cranial implant-retained prosthetic reconstructions have been proved to be highly successful. Replacement of the eyes, ears, nose, and larger areas including combined midface defects, which frequently have no other option available, has been done successfully. Burn patients and those with congenital defects are good candidates for this type of reconstruction, especially after autogenous attempts have failed. Cranial implant prosthetic reconstruction should be considered as a viable option for difficult craniofacial defects., (Copyright © 2011. Published by Elsevier Inc.)

Temporal hollowing due to temporal muscle atrophy after standard skull base surgery is common. Various techniques have been previously described to correct the disfiguring defect. Most often reconstruction is performed using freehand molded polymethylmethacrylate cement. This method and material are insufficient in terms of aesthetic results and implant characteristics. We herein propose reconstruction of such defects with a polyetheretherketone (PEEK)-based patient-specific implant (PSI) including soft-tissue augmentation to preserve normal facial topography. We describe a patient who presented with a large temporo-orbital hemangioma that had been repaired with polymethylmethacrylate 25 years earlier. Because of a toxic skin atrophy fistula, followed by infection and meningitis, this initial implant had to be removed. The large, disfiguring temporo-orbital defect was reconstructed with a PEEK-based PSI. The lateral orbital wall and the temporal muscle atrophy were augmented with computer-aided design and surface modeling techniques. The operative procedure to implant and adopt the reconstructed PEEK-based PSI was simple, and an excellent cosmetic outcome was achieved. The postoperative clinical course was uneventful over a 5-year follow-up period. Polyetheretherketone-based combined bony and soft contour remodeling is a feasible and effective method for cranioplasty including combined bone and soft-tissue reconstruction of temporo-orbital defects. Manual reconstruction of this cosmetically delicate area carries an exceptional risk of disfiguring results. Augmentation surgery in this anatomic location needs accurate PSIs to achieve satisfactory cosmetic results. The cosmetic outcome achieved in this case is superior compared with previously reported techniques.

Introduction: Controversy still exists regarding the choice of implant material for orbital floor reconstructions, in particular the use of silicone. We aimed to evaluate the long-term outcomes of orbital floor reconstructions with silicone versus other non-silicone implants., Patients and Methods: We conducted a 12 year retrospective review of patients who had orbital floor reconstructions for fractures at the Royal Hobart Hospital, Tasmania, Australia, from 1995 to 2007. Surgical admission notes, CT reports, operation records, outpatient notes, and complications were recorded. Long-term follow-up consisted of a structured telephone interview assessing patient outcomes and satisfaction, including ongoing disability, following orbital floor repair., Results: Eighty one patients were identified as having had orbital floor reconstruction with an implant. Mean long-term follow-up was 63 months. Outcomes of Silicone implants (n=58) were compared to non-silicone implant materials (n=23) including titanium mesh, 'Lactasorb', 'Resorb-X', autologous cartilage, and bone graft. Statistically significant advantages in the silicone group were found in the number of patients with palpable implants (24% vs 63%, p=0.005), the number of patients without any complaint (67% vs 32%, p=0.004), and the number of patients requiring subsequent surgery for complications related to their implants (5% vs 23%, p=0.046)., Conclusion: The appropriate use of silicone implants for orbital floor reconstruction can have good results, contrary to much of the literature, with low complication rates including an acceptably low rate of infection and extrusion, as well as high patient satisfaction. To establish definite guidelines for best surgical practise, particularly amongst synthetic implant materials, prospective study is required., (Copyright 2009. Published by Elsevier Ltd.)

Craniofacial prostheses (or epitheses) are artificial substitutes for facial defects. Today, prostheses made of silicone are state-of-the-art. They may be fixed anatomically (to already existing structures), mechanically (to spectacle frames), chemically (using adhesives), or surgically (to osseointegrated titanium implants). With the existing extraoral implant systems, prostheses may be securely anchored to the bone regardless of size and location of the defect. The classic atraumatic surgical technique has remained an unchanged prerequisite for successful implantation by avoidance of any heat trauma to the bone. This review outlines the indications and contra-indications as well as advantages and disadvantages of craniofacial prostheses and their retention methods in various facial regions. It summarizes the basic principles of extraoral implantology in respect to implant positioning and the management of children and radiated patients.

Home made siloxan material <> for making external face prosthesis was introduced into clinical practice. Original technique of making external face prosthesis for defects and deformations of middle zone of face based upon making individual prosthetics according to esthetic requirements of the patient was developed. Stable staining of the composition <> by nontoxic pigments of the <> brand with the possibility of repetitive color corrections of the ready external prosthesis let to achieve high esthetic and functional result.

Background: Narrow palpebral fissures, short lower lids, and full cheeks are hallmarks of youthful periorbita. The presence of these features is predicated on a convex upper midface skeleton. Faces whose midface skeletons are flat or concave do not manifest these youthful attributes, tend to age prematurely, and are prone to lower lid malposition after blepharoplasty., Methods: Augmentation of the infraorbital rim with alloplastic implants can provide convexity to the deficient upper midface skeleton. Suspension of the cheek soft tissues (subperiosteal midface lift) on this now supportive framework narrows the palpebral fissure, shortens the lower lid, and gives fullness to the cheek. The addition of lateral canthopexy to skeletal augmentation and subperiosteal midface lift can restore lower lid position when previous blepharoplasty has resulted in lower lid malposition in patients with deficient midface skeletons., Results: This concept has been utilized in 87 patients (65 female, 22 male) over the last 7 years. Of these 87 patients, four patients (5 percent) required revision surgery to correct implant malposition or prominence. Three patients (3 percent) required implant removal to treat infection. Implants were later replaced in two of these three patients., Conclusions: Augmentation of the infraorbital rim with alloplastic implants provides convexity to the upper midface skeleton. Together with lower lid and midface soft-tissue suspension, it creates or restores youthful periorbital aesthetics.

Traditional theories on facial aging and methods for rejuvenation focus primarily on soft tissues with ptosis as the major mechanism responsible for senescent changes. Anatomic studies demonstrate that there are also many changes to the craniofacial skeleton as patients age. Midface skeletal augmentation, using implants made of porous polyethylene, is a simple and effective method to reverse age-related changes of the facial skeleton in patients with intact occlusion. Skeletal implants correct concave morphology by increasing projection and provide a means to resuspend cheek soft tissues that have descended off a deficient bony platform. Beyond rejuvenation, skeletal implants can be used to restore facial proportions in patients with midface deficiency secondary to trauma, congenital deformity, or other pathologic states., (Copyright Thieme Medical Publishers.)

Objective: To evaluate the efficacy of porous polyethylene sheet implants in reconstruction of orbital blow-out fractures., Methods: Sixty-eight patients with orbital blow-out fractures were admitted in our center from December 1996 to June 2005. Porous polyethylene sheet implants were used to repair the defects of orbital wall and to correct the enophthalmos. The clinical results of extrinsic eye movement, enophthalmos, hypoglobus (vertical dystopia), visual acuity, and infraorbital nerve anesthesia were analyzed preoperatively and postoperatively., Result: Patients stayed in the hospital between 4 and 10 days. The enophthalmos and hypoglobus of all 68 patients was corrected except for one. The patient needs another surgery 6 months after operation to remove a piece of Medpor because the hypoglobus was overcorrected. Diplopia was resolved in 36 of 45 patients postoperatively. Persistent diplopia was found in 9 cases that were complicated orbitozygomaticomaxillary fractures. Visual acuity was improved in 13 of 45 patients, whereas no change was observed in the others. Infraorbital nerve hypoesthesia was resolved in 32 of 43 cases 6 months after operation. Only 1 patient developed postoperative ectropion, for which local suspending was required. No infections and Medpor outcrop were seen after operation., Conclusion: Porous polyethylene sheet implant is a very reliable material for reconstruction of the orbital blow-out fractures and restoration of the orbital volume. Overcorrection of 1 to 2 mm is necessary during operation to neutralize the tissue swelling or atrophy.

Reconstruction of zygomatico-orbital complex remains as one of the troublesome and topical problems at steady posttraumatic deformations and fresh traumas of the mentioned region. The present work provides analysis of our own experience of surgical treatment of patients suffering from posttraumatic deformations and defects of zygomatico-orbital complex. The work was based on the results of examination and treatment of 33 patients who underwent an operation during the period from 2003 to 2008 years. Of 33, 21 patients were operated due to fresh traumas of the zygomatico-orbital region, and 12 - due to steady posttraumatic deformations of the mentioned region. Of 33 clinical cases, 19 patients underwent reconstruction of zygomatico-orbital complex with the use of implant. In 11 cases implants were perforated titanic plates, in 6 cases - bone cement (Surgical Simplex P), and in 2 cases - combination of titanic plates with bone cement. The results of our investigations have shown that one-stage reconstruction of zygomatico-orbital complex with the use of titanic plates and bone cement liquidates functional and cosmetic disorders. It has been suggested that the use of elaborated complex approaches in treatment of posttraumatic deformations and fresh traumas of zygomatico-orbital region is reasonable and acceptable.

High-density porous polyethylene (Medpor Surgical Implants, College Park, GA) enophthalmic implants are used in patients with sunken socket syndrome to augment the orbital volume. A transconjunctival or subciliary approach is used to access the orbital floor. We present a new approach for accessing the orbital floor using diced Medpor implants through a mini-lateral canthoplasty incision. Medpor particles diced about 1 x 1-cm diameter were inserted through alateral canthal incision to orbital floor. The advantages of this technique are limited incision, decreased postoperative edema, volumetric adjustability, and applicability under local anesthesia. Three cases with blow-out and neglected zygomaticomaxillary fractures underwent primary or secondary diced Medpor orbital implantation. No cases showed any implantial infection. Our preliminary results showed no complication, and this novel method seems to have no severe disadvantage in the surgical treatment of posttraumatic enophthalmos.

The success rates of craniofacial osseointegrated implants are not uniform throughout the craniofacial area. A better understanding of their clinical behaviour is needed. This article investigates current perspectives on the application of endosseous implants in the restoration of craniofacial defects. An online search was completed for the time period from 1966 to 2007, along with a manual search, to locate relevant peer-reviewed articles and textbooks published in English. A review of published reports of craniofacial application of endosseous implants in irradiated and nonirradiated tissue sites showed a strong correlation between anatomic sites and clinical success. Maxillofacial prosthetic considerations are also reviewed.