Surgical Rehabilitation of a Continuous Orbital and Maxillary Defect from Rhino-Orbital Mucormycosis Utilising Digital Technology - A Case Report

Abstract

Rationale: COVID-19 has led to a resurgence in cases of mucormycosis, especially the rhino-orbital form affecting the oral cavity, nasal, orbital and cerebral regions.

Patient concerns: The surgical treatment in this patient led to the exenteration of orbital contents and segmental maxillectomy of the affected side leading to facial disfigurement and inability to masticate.

Diagnosis: A combined mucormycosis-associated oro-orbital defect was present leading to a communication between oral and orbital cavities.

Treatment: Rehabilitation utilising digital technology for removable prosthesis was planned for the combined orbital and oral defect.

Outcomes: The independent intraoral and orbital prosthesis reduced the mobility of the orbital prosthesis while performing functional movements. The advancements in digital technology led to the convenient and resilient fabrication of prostheses for large facial defects.

Take-away lessons: The prosthetic rehabilitation of a continuous orbital and oral defect with a hybrid of both digital and conventional means provided an aesthetic, feasible and financially sound solution to the patient.

Keywords: Hollow obturator; orbital exenteration; segmental maxillectomy; three-dimensional printing.

Figure 1

(a and b) Extraoral and intraoral defect, (c) 3D reconstruction of the data, (d) Digital designing of conformer with mechanical grooves, (e) Depiction of hollowness of conformer, (f) Trial of conformer

Figure 2

(a) Facial moulage impression with conformer pickup, (b) Transfer of the distance between the glabella and centre of the iris of the natural eye to defect side, (c) Final iris positioning using a Fox plane analyser, (d) Placement of acrylic stalk over the iris

Figure 3

(a) Fabrication of mould following dewaxing, (b) Cured prosthesis, (c) Prosthesis following weaving of eyebrow, (d) Prosthesis reinforced with eyewear

Figure 4

(a) Interim obturator in situ, (b) Designing of 3D printed cast partial framework, (c) Adaptation of framework on the altered cast, (d) Try-in of the intraoral prosthesis, (e) Adaptation of putty index between the wax spacer and framework, (f) Intraoral prosthesis in situ