Retinoblastoma is a highly malignant neoplasm. Most of the cases are usually far advanced at the time of detection, requiring enucleation to salvage the child's life. However, the cosmetic rehabilitation of these patients should always be an integral part of their treatment, which helps in their re-integration in the society. This paper presents a case of 5-year-old patient who had undergone enucleation of her left eye due to retinoblastoma. A multidisciplinary approach, including ophthalmologist, psychotherapist, and a prosthodontist, was adopted to meet her physical, psychological, functional, emotional, social, and cosmetic demands. The patient was rehabilitated cosmetically with precisely fabricated ocular prosthesis. An ocular prosthesis is a highly positive and non-invasive approach to improve the cosmetic appearance and psychological well-being of patient.
Artificial eye; Custom ocular prosthesis; Enucleation; Ocular defect; Retinoblastoma
The fundamental objective in restoring a congenital as well as acquired defect of eye with an ocular prosthesis is to enable the patient to cope better with the difficult process of rehabilitation after an enucleation or evisceration. A cosmetically acceptable prosthesis is that reproduces the color, form and orientation of iris and allows the patient to return to accustomed lifestyle. A sequence of steps for construction of custom-made ocular prostheses is outlined in this case report using the advantages of digital imaging technique.
Custom-made ocular prosthesis; Photographic iris; Digital imaging
Although conjunctival squamous cell carcinoma is known to develop as a result of chronic irritation from wearing an ocular prosthesis, orbital sebaceous gland carcinoma arising in an anophthalmic pocket is extremely rare. We report a 68-year-old female who developed a sebaceous gland carcinoma 65 years after her right eye was enucleated (at the age of three years) due to congenital glaucoma. The patient had noticed increasing discharge and swelling of her right eyelid. Incisional biopsies of an underlying orbital mass revealed poorly differentiated sebaceous gland carcinoma. The sebaceous gland carcinoma in this case could have been caused by chronic irritation as a result of long-standing use of a poorly fitted ocular prosthesis. The current case of a malignant tumor occurring 65 years after enucleation emphasizes the importance of long-term clinical surveillance to monitor for tumor formation. Careful examination of the anophthalmic socket should be part of the physical examination.
sebaceous gland carcinoma; anophthalmos; orbit
Retinoblastoma is a highly malignant neoplasm. Most of the cases are usually advanced at the time of detection, requiring enucleation to salvage the child's life. Just treating the patient for cancer is not enough; the cosmetic rehabilitation of these patients is equally important and it should always be an integral part of their treatment, to help them re-integrate in the aesthetic conscious society. Rehabilitating such patients require a multidisciplinary approach involving the combined and timely efforts of an ophthalmologist, paediatric oncologist and a skilled maxillofacial prosthodontist. This paper presents a case of 3½-year-old girl who had enucleation of her right eye due to retinoblastoma along with chemotherapy and radiotherapy at the age of 3 years. The patient was recalled regularly for follow-up at 3 month intervals for ophthalmic examinations and she was rehabilitated cosmetically with customised ocular prosthesis during the various stages of her developmental growth.
Custom ocular prosthesis; enucleation; impression technique; ocular defect; retinoblastoma
The primary objectives of successful prosthetic rehabilitation are to provide function, esthetics and comfort to the patient. Combination prosthesis is one which is supported by both natural teeth and implant. The periodontal ligament and osseointegrated interface distribute force differently to the supporting bone. Therefore problems can develop when tooth and implants are combined in the same prosthesis. However, clinicians can apply biomechanical principles, to negate the deleterious leverages exerted by the fixed prosthesis by using non rigid components and to equalize the stress applied by the prosthesis on implant and teeth. A case of partially edentulous situation was rehabilitated successfully with a combination of prostheses. Maxillary arch was restored to function with crowns, fixed dental prosthesis and with an extra coronal castable attachment prosthesis and the mandibular arch with a combination of tooth and implant supported attachment prosthesis. The clinical and laboratory steps for the fabrication of these prostheses are explained in this report.
Implant; Attachment; Combination prosthesis; Implant overdenture
Ocular prosthesis motility was measured and compared in 15 patients with a primary baseball implant after enucleation of an eye, in 11 patients with a secondary baseball implant, in 12 patients with an Allen implant, and in 11 patients without any intraorbital implant. In all patients a noticeable lag of movement of the prosthetic eye was measured: in the extreme directions of gaze the excursions of the prosthesis were far less in comparison with the contralateral normal eye. For normal eye movement round the primary position of gaze, however, the prosthesis motility in the primary baseball and Allen implant group appeared to be sufficient to give a lifelike appearance. The average motility of the prostheses in these two groups did not differ. The motility in the secondary baseball group and in the group without an implant was evidently worse. In the last group the prosthesis motility was most impaired. We conclude that the insertion of an implant, even when inserted some time after the enucleation (a secondary implant), improves the motility of the prosthesis markedly. We recommend the primary baseball implant as the correction of choice after enucleation.
Following Total Laryngectomy, Tracheo-oesophageal speech prosthesis offers the most reliable form of voice rehabilitation. Of the various prostheses currently available. The Provox voice prosthesis developed by the Netherlands Cancer Institute has been the most popular due to its superior design and in-dwelling nature.
At the Apollo Cancer Hospital, Hyderabad, 17 patients underwent speech rehabilitation with the Provox voice prosthesis between February 1999 and July 2000. Speech rehabilitation was successful in all patients with the majority (82%) developing Good—Excellent speech. Two patients required replacement and one patient discontinued use of the prosthesis. There were no complications in any of the other patients.
Provox voice prosthesis; speech rehabilitation; tracheo-oesophageal prosthesis
The coral-derived hydroxyapatite sphere is a popular, new integrated orbital implant designed to provide improved motility of the ocular prosthesis following enucleation. Although the implant has rapidly become widely used by ophthalmologists, there is little information available regarding the complications of this technique in a large series of cases. We report our results on our initial 250 consecutive cases of hydroxyapatite implantation for eyes enucleated primarily for intraocular neoplasms, with specific emphasis on the complication an their management. The reasons for enucleation included uveal melanoma (157 cases), retinoblastoma (70 cases), blind painful eye (22 cases), and intraocular medulloepithelioma (1 case). Prior treatment to the eye was performed before enucleation in 47 cases and included repair of ruptured globe (17 cases), plaque radiotherapy (18 cases), external beam radiotherapy (6 cases), and others (6 cases). During a mean of 23 months follow-up (range, 6 to 42 months), there have been no recognizable cases of orbital hemorrhage related to the implant and no cases of implant extrusion or implant migration. There was one case of presumed orbital infection (culture-negative) that resolved with intravenous antibiotics, and the implant was retained within the orbit. Other problems included conjunctival thinning in eight cases managed by observation and prosthesis adjustment and conjunctival erosion in four cases managed by combinations of scleral patch graft, conjunctival flap, and prosthesis adjustment. The conjunctival erosion was caused by a poorly fitting prosthesis in three cases and wound dehiscence in one case. The complication rate in eyes receiving prior radiotherapy or surgery was not increased. The hydroxyapatite integrated orbital implant is a well-tolerated motility implant without the high rate of extrusion and infection seen with other motility implants.
Rehabilitation of facial defects is a complex task, requiring an individualized design of the technique for each patient. The disfigurement associated with the loss of an eye may result in significant physical and emotional problems. Various treat-ment modalities are available, one of which is the use of implants. Although implant-supported orbital prosthesis has a su-perior outcome, it may not be advisable in all the patients due to economic factors. The present article describes a simplified technique for the fabrication of a silicone orbital prosthesis by constructing a custom ocular prosthesis to achieve ideal fit and aesthetics. Multidisciplinary management and team approach are essential in providing accurate and effective rehabilitation.
Artificial; eye; ophthalmia; orbit
Mutilation of a portion of a face can cause a heavy impact on the self-image and personality of an individual. Acceptable cosmetic results usually can be obtained with a facial prosthesis. This paper describes prosthetic rehabilitation of a 60-year-old male patient having a left ocular defect. A technique to fabricate heat polymerizing polymethyl methacrylate was illustrated. The resultant prosthesis was structurally durable and aesthetically acceptable with satisfactory retention. The importance of meticulous treatment planning to tackle the challenges faced in fabricating an ocular prosthesis is explained with the relevant literature.
The coral derived hydroxyapatite sphere is a popular, integrated orbital implant designed to provide improved motility of the ocular prosthesis following enucleation. Although the implant has rapidly become widely used by ophthalmologists, little information is available regarding the problems of this technique in a large series of cases. Experience with 250 consecutive cases of hydroxyapatite orbital implant use was reviewed and the problems of the implants and their management investigated specifically. The reasons for enucleation included uveal melanoma (157 cases), retinoblastoma (70 cases), blind painful eye (22 cases), and intraocular medulloepithelioma (one case). Earlier treatment to the eye was performed before enucleation in 47 cases and included repair of ruptured globe (17 cases), plaque radiotherapy (18 cases), external beam radiotherapy (six cases), and others (six cases). During a mean of 23 months' follow up (range 6-40 months), there have been no recognisable cases of orbital haemorrhage related to the implant, and no cases of implant extrusion or implant migration. There was one case of presumed orbital infection (culture negative) that resolved with intravenous antibiotics and the implant was retained within the orbit. Other problems included conjunctival thinning in eight cases managed by observation and prosthesis adjustment, and conjunctival erosion in four cases managed by combinations of scleral patch graft, conjunctival flap, and prosthesis adjustment. The conjunctival erosion was caused by a poorly fitting prosthesis in three cases and wound dehiscence in one case. The problem rate in eyes receiving prior radiotherapy or surgery was not increased. The hydroxyapatite integrated orbital implant is a well tolerated motility implant without the high rate of extrusion and infection seen with other motility implants. The prosthesis fit may contribute to the tolerance of the implant.
Mutilation of a portion of a face can cause a heavy impact on the self image and personality of an individual. Surgical removal of an eye is a severe handicap to a patient because the most important sensory organ of communication is lost. Depending on the severity of the defect Ocular/Orbital prosthesis are required in these patients for rehabilitation. This case report details the clinical management of a patient following enbloc removal of an eye. Fabrication of a sectional two piece orbital prosthesis has been detailed. The importance of meticulous treatment planning to tackle the challenges faced in fabricating an orbital prosthesis is explained with relevant literature.
Orbital defect; Sectional orbital prosthesis; Inverted anatomic tracing; Posterior indexing method
The technician by virtue of his profession plays an important role in fabricating silicone tongue prosthesis for a total glossectomy patient. The technician, with his skills and specialized knowledge in handling material, plays a valuable role as a member of the oncology team. A patient with total glossectomy can be rehabilitated by silicone tongue prosthesis as an aid to improve his speech and swallowing. This paper describes the technical steps involved in fabricating a silicone tongue prosthesis for an edentulous total glossectomy patient.
Ectodermal dysplasias are rare hereditary disorders characterized by abnormal development of certain tissues and structures of ectodermal origin. The condition is important for dentists as it affects teeth resulting in hypodontia or anodontia and dentist plays an important role in rehabilitation of the patient. Affected young children with anodontia not only have difficulties in eating and speaking but can also feel that they look different from their contemporaries. Well-fitting and functioning prosthesis could be a great help during their schooling years as it will improve appearance and thus boost their self confidence. We report a case of hypohidrotic ectodermal dysplasia in an 8-year-old boy who exhibited anodontia and was successfully rehabilitated with conventional complete dentures in both maxillary and mandibular arches. The aim of the treatment was to improve psychological development apart from promoting better functioning of the stomatognathic system.
Anodontia; Complete dentures; Dental implants; Ectodermal dysplasia
As a preparatory step towards the development of a complete habilitation program for children with congenital limb anomalies associated with maternal ingestion of thalidomide, the medical records of all patients with congenital limb anomalies referred to the Rehabilitation Institute of Montreal in the past decade were studied, and an examination and a thorough reassessment were made of 41 patients (21 males and 20 females). The medical and prosthetic aspects were dealt with in Part I of this paper. Part II describes, in a joint report, the results of psychiatric, psychological and educational assessments.
There was no evidence of major emotional disorder in any of the patients, although conflicts were intensified by the presence of the physical anomaly. No relation was found between intelligence, emotional adjustment and disability. The patient's attitude towards his disability and prosthesis is definitely influenced by the degree of parental acceptance of the handicap and by the character of the emotional undertones in the total environment. In order to favour the occurrence of the healthiest modes of development in these children, the authors believe that the medical profession should be made fully aware of the physical and emotional problems which may arise after the birth of a deformed child. It is considered very important that the mother should receive psychotherapeutic support as soon as possible after the child is born.
Prosthetic rehabilitation in post-oncologic patients after bone reconstruction are not substantially different than those of patients affected by severe atrophia of upper or lower jaw after bone reconstruction.
Aim of this paper is to evaluate the possibilities of prosthetic rehabilitation on these patients and to present our method. Prosthesis-based oral rehabilitation of such tumor cases rapresents a challenge.
The report analyses two cases of patients who underwent ablative oral surgery. Both have received a fibula free vascularised flap. The first was rehabilitated with a removable prosthesis fixed on the residual teeth, while the second with an implant supported prosthesis.
In case of carcinoma resection of the oral mucosa, the removable prosthesis guarantees a simplification in dental care operations. On the other hand, irradiated mucosa is frequentely unable to tolerate the friction created by the acrylic base. However, the fixed prosthesis can limit the view during follow-up controls.
In our school, according to all exposed reasons, we consider the implant supported overdenture prosthesis to be the best choice for those patients.
oral cancer; fibula free flaps; oral rehabilitation; function
Loss of voice is a major concern after total laryngectomy. Tracheo-esophageal prosthesis was described in 1980 by Blom and Singer as a method of postlaryngectomy voice rehabilitation. Since then it has seen many phases of developments. Now it has evolved into highly effective method with success rates more than 90% and better quality of voice than other modalities. It also gives good quality of life and voice related quality of life. Though it is associated with some complications, they are easy to manage. All these have made tracheo-esophageal prosthesis the ‘Gold Standard’ of post-laryngectomy voice rehabilitation.
TEP; Tracheo-esophageal; laryngectomy; voice; rehabilitation
An ocular defect may affect a patient psychologically. An ocular prosthesis is given to uplift the patient psychologically and improve the confidence. Ocular prosthesis can be custom made or a stock shell. To improve the comfort and matching of the prosthesis with that of the adjacent natural eye an custom made ocular prosthesis is preferred. Different techniques are available to fabricate a custom ocular prosthesis, here we have used paper iris disk technique.
Ocular impression; ocular prosthesis; Iris painting; scleral blank
Large oro-facial defects result from cancer treatment consequences in serious functional as well as cosmetic deformities. Acceptable cosmetic results usually can be obtained with a facial prosthesis. However, retention of a large facial prosthesis can be challenging because of its size and weight. This article describes prosthetic rehabilitation of a 57-year-old man having a right lateral mid-facial defect with intraoral-extraoral combination prosthesis. A modified technique to fabricate a hollow substructure in heat-polymerizing polymethyl-methacrylate to support silicone facial prosthesis was illustrated. The resultant facial prosthesis was structurally durable and light in weight facilitating the retention with magnets satisfactorily. This technique is advantageous as there is no need to fabricate the whole prosthesis again in case of damage of the silicone layer because the outer silicone layer can be removed and re-packed on the substructure if the gypsum-mold is preserved.
Extraoral surgical defects; Intraoral-extraoral combination prosthesis; Magnet retained prosthesis; Midfacial defects; Silicone facial prosthesis
When geriatric patients with maxillofacial defects are handled, the clinician must be confident of addressing and managing the psychology of these patients. It is also required that the clinician must understand and be sensitive to the medical and financial states of geriatric patients. The loss of an eye has a far-reaching impact on an individual’s psychology and an immediate replacement is necessary to promote the physical and psychological healing of the patient and to improve his/her social acceptance. Special approaches and treatment goals are considered while treating geriatric patients with ocular defects and special consideration is given to the appointment length, the number of appointments and their medical and financial statuses. This article presents the prosthetic rehabilitation of a geriatric patient with an ocular defect, with a customized stock ocular prosthesis, by using a minimal intervention geriatric approach.
Ocular prosthesis; Geriatric patient; Stock ocular prosthesis
The oral health being an integral part for the healthy living, necessity of disability limitation and rehabilitation in oral health has taken a paramount role. To assess the prosthetic status and to evaluate the prosthetic needs of the patients attending various institutes of Ahmedabad and Gandhinagar district. A total of 510 (264 males and 246 females) subjects at various dental institutes were examined in the study. A survey proforma was prepared with the help of WHO oral health assessment form (1997). Prosthetic status and prosthetic treatment need was recorded. Out of 510, any type of Edentulousness was 322 (63 %). Among them, 254 (49.8 %) were partially edentulous while 68 (13.3 %) were completely edentulous. Only 69 (13 %) were having any prosthesis in upper arch while only 80 (16 %) were having any prosthesis in lower arch. Need for any type of prosthesis in upper and lower arch was 55 and 60 % in males and females, respectively. In lower social class group need of prosthesis in upper and lower arch was 62 and 63 %, respectively. It was found that prosthetic status and prosthetic treatment need increased with increase in age. Steps should be taken to overcome this disparity and more emphasis should be given to meet the felt need of the people through government and non government organizations to improve the oral health. The unmet prosthetic treatment need should be met to rehabilitate needy people so that their disability may be limited.
Prosthetic status; Prosthetic treatment need; Socioeconomic group
Rationale: Enucleation implants are covered with a material that allows the fixation of the extraocular rectus muscles. Usually, the implants are covered in donor sclera, which implies the risk of infection transmission, inflammation and implant rejection, being also an expensive procedure. The new materials used for implant meshing should be tested and a safer and cost effective solution should be researched.
Objective: This study presents the results obtained after a 15-year use of an original prosthesis for the reconstruction of the orbital cavity after enucleation surgery.
Methods and results: 42 eyes of 42 patients who underwent enucleation surgery for choroidal malignant melanoma were included in the study. The surgical technique was very similar to the classic enucleation, the major difference being the implant of a prosthesis made out of a Polymethyl methacrylate (PMMA) ball covered by a Polyethylene terephthalate (dacron) shell used in cardiovascular surgery. All the patients had a very good technical result, without the inflammation of the orbital cavity, conjunctiva or eyelids, which demonstrates a very high material tolerability and an excellent cosmetic result. Late implant expulsion appeared in 7.14% of the patients (3 cases).
Discussion: The particularly good results obtained by using this technique, the absence of an inflammatory reaction after surgery, and the long lasting stability of the implant, recommend the method as being safe, with no major complications and a good esthetic result.
AbbreviationsPolymethyl methacrylate (PMMA), Malignant choroidal melanoma (CMM)
Choroidal malignant melanoma; enucleation; Polyethylene terephthalate; Dacron
It is the god given right of human being to appear human, and the face is a person’s visiting card. We can hide everything but we can’t hide our face. Eyes are generally the first feature of the face to be noticed and the presence of a pair of eyes is quite essential to maintain the balance and the esthetics of the face. Loss of eye has a crippling effect on the psychology of the patient. The aim of all ocular prosthetic procedure is to enable rehabilitation of the patient in the society with a normal appearance and self esteem. This article describes a clinical report of rehabilitating post evisceration patient due to glaucoma of right eye with custom made artificial prosthesis using stock eye shell that can create esthetically pleasing results.
Custom made; Ocular prosthesis; Evisceration; Stock eye shell
An implantable prosthesis that stimulates vestibular nerve branches to restore sensation of head rotation and vision-stabilizing reflexes could benefit individuals disabled by bilateral loss of vestibular (inner ear balance) function. We developed a prosthesis that partly restores normal function in animals by delivering pulse frequency modulated (PFM) biphasic current pulses via electrodes implanted in semicircular canals. Because the optimal stimulus encoding strategy is not yet known, we investigated effects of varying biphasic current pulse frequency, amplitude, duration and interphase gap on vestibulo-ocular reflex (VOR) eye movements in chinchillas. Increasing pulse frequency increased response amplitude while maintaining a relatively constant axis of rotation. Increasing pulse amplitude (range 0–325 μA) also increased response amplitude but spuriously shifted eye movement axis, probably due to current spread beyond the target nerve. Shorter pulse durations (range 28–340 μs) required less charge to elicit a given response amplitude and caused less axis shift than longer durations. Varying interphase gap (range 25–175 μs) had no significant effect. While specific values reported herein depend on microanatomy and electrode location in each case, we conclude that PFM with short duration biphasic pulses should form the foundation for further optimization of stimulus encoding strategies for vestibular prostheses intended to restore sensation of head rotation.
vestibular; neural; prosthesis; pulse duration; interphase gap; electrical stimulation; vestibular implant
Bilateral loss of vestibular sensation causes difficulty maintaining stable vision, posture and gait. An implantable prosthesis that partly restores vestibular sensation could significantly improve quality of life for individuals disabled by this disorder. We have developed a head-mounted multichannel vestibular prosthesis (MVP) that restores sufficient semicircular canal function to recreate a 3D angular vestibulo-ocular reflex (aVOR). In this study, we evaluated effects of chronic MVP stimulation on locomotion in chinchillas. Two of three animals examined exhibited significant improvements in both locomotion and aVOR.