Effectiveness and safety comparison of three eye and orbital reconstruction techniques in facial plastic surgery

Management of post enucleation socket syndrome patients - A retrospective study

The aim of this retrospective monocentric study was to report the outcomes following the correction of post enucleation socket syndrome (PESS) as well as the factors predicting for a multistep management. Patients were included, if they had received surgery to manage PESS. Demographics and patient history were collected. The symptoms of PESS were clinically rated by the same surgeon and ocularist, preoperatively and after each procedure. The surgery was considered as successful when no PESS clinical symptoms were observed. A prognostic study was performed to investigate the surgical outcomes. RESULTS: Thirty-six patients were included and eight of them had their PESS corrected after the first surgery. In the multivariate analysis (MVA), the deep upper lid sulcus symptom remained the main significant factor associated with an incomplete correction after the first surgery (OR 45.5, IC 95% (3.481-594.6), p = 0.004). For further corrections, the ptosis was the only significant prognostic factor requiring several surgeries (p = 0.005). At the end of the management, 94.4% of the patients had satisfying outcomes. CONCLUSIONS: The management of a PESS involves the correction of both the orbital cavity and the soft tissues. Although its correction is complex and time consuming in the majority of cases, the patients should be informed that the final cosmetic outcomes remain good at the expense of several surgeries.

Incidence and Risk Factors of Moderate to Severe Postoperative Pain Following the Placement of Primary and Secondary Orbital Implants: A Prospective Observational Study

PURPOSE

To prospectively explore the incidence and risk factors of moderate to severe pain after primary and secondary orbital implantation following evisceration or enucleation surgery.

METHODS

One hundred eighteen patients under general anesthesia for orbital implantation were enrolled in this study. In 91 patients, primary orbital implantation followed evisceration, and in 27 patients, the implantation was secondary after previous evisceration or enucleation surgery. Medical interventions for all participants were followed by standardized surgical, anesthetic, and analgesic protocols. Postoperative pain (POP) intensity was quantified by an 11-point numerical rating scale within 72 hours after the surgery, numerical rating scale ≥4 was considered moderate to severe POP. Multivariate logistic regression was utilized to identify the risk factors related to the development of POP.

RESULTS

Thirty-five patients (29.7%) displayed moderate to severe POP, particularly within 6 to 24 hours after surgery, which peaked at 24 hours. Of these patients, 26 patients who were unable to tolerate the pain received additional doses of analgesics during in-hospital stay. Logistic regression model revealed that preoperative anxiety (odds ratios = 4.890; p = 0.002), congenital microphthalmia (odds ratios = 14.602; p = 0.038), and surgical time longer than 60 minutes (odds ratios = 5.586; p = 0.001) were significantly associated with moderate to severe POP after orbital implantation.

CONCLUSIONS

Orbital implantation after evisceration or enucleation surgery is likely to cause moderate to severe pain intensity in the early postoperative period. Preoperative anxiety, prolonged surgical time, and congenital microphthalmia were the risk factors.

A triple-layered closing technique using the recti muscles to augment implant coverage in eye enucleation after maxillofacial radiotherapy: A case report

Eye enucleation (EE) of a previously irradiated orbit can lead to difficult wound closure due to the soft tissues fibrosis such as Tenon's capsule and conjunctiva. We, here, report a technique modification for EE surgery after facial radiotherapy that may decrease implant exposure by using recti muscles native tissue to reinforce the anterior implant coverage. A 71-year-old African male presented in 2003 a right orbital extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) type. He was treated with chemotherapy followed by whole orbital radiotherapy. His right vision remained impaired due to phtisis bulbi secondary to facial radiotherapy. By 2017, he developed right painful phthisis bulbi. Radiological systemic staging did not reveal any recurrence or metastasis. Because of the history of neoplasia, the right eye had to be enucleated. Due to tissue fibrosis secondary to radiotherapy, we took care to preserve as much conjunctiva and Tenon as possible. EE was performed under general anesthesia. EE consisted of a standard procedure with a modified triple-layered closing technique. The four recti muscles were attached with 5-0 Vicryl to the anterior part of the implant by passing the needle through the tunnels and tying the suture. The horizontal muscles were spread with a forceps to cover the lateral and medial part of the implant. The vertical muscles were spread with a forceps to cover the superior and the inferior part of the implant. Finally the edges of the recti muscles were sutured to each other with 5-0 Vicryl to create a muscle layer. Tenon's capsule and conjunctiva were closed separately, using horizontal interrupted 6-0 Vicryl sutures. One year after surgery, wound closure was complete with no sign of extrusion. The triple-layered closing technique using the recti muscles in EE represents a potentially viable alternative to augment implant coverage in case of Tenon and conjunctival fibrosis secondary to facial radiotherapy.