[Rehabilitation with bone anchored facial prostheses]

Abstract

Background: Rehabilitation of orbita defects with loss of eyelids is difficult to achieve with plastic surgery. Here defect coverage with a facial prosthesis shows good results.

Patients and methods: 105 patients with orbita defects were treated since 1991 with bone anchored facial prostheses. Preoperatively we measured the bone availability with computed tomography. We inserted Brånemark-titanium implants (Fa. Nobel Biocare), with a two-stage procedure. After a period of at least three months we exposed implants and connected the supraconstruction. Then our anaplastologist produced the facial prosthesis, either a "soft" facial prosthesis of silicone or a "solid" prosthesis of polymethylmetacrylate (PMMA). Not later than every three months patients came to recall.

Results: For all patients we found enough bone for implantation. The implants were screwed into the lateral bony orbital margin. There were no intraoperative complications accompanying implant insertion. For 96 patients we chose the silicone material; for nine patients we did produce the facial prosthesis of PMMA. In about 10.5% of the implants we had to remove subcutaneous tissue in local anesthesia because of recurrent periimplantary inflammations. Three years after insertion 95.8% of the implants were still firmly anchored in the bone.

Conclusions: Performed by the experienced specialist the prosthetic treatment of orbita defects with a bone anchored facial prosthesis is a cosmetically satisfactory procedure with good long-term outcome. While modern plastic materials can replace the lost tissue with deceptively natural results, the implants guarantee firm secure retention of the facial prosthesis.