Therapeutic Strategy for the Triad of Acquired Anophthalmic Orbit

Abstract

In treating patients with anophthalmic orbits, it is essential to achieve a long-lasting natural appearance and comfortable retention of eye prostheses. In 1992, the authors developed a therapeutic strategy based on a simple algorithm for treating the three common symptoms of acquired anophthalmic orbit: severe eye socket contracture is surgically treated with a radial forearm free flap transfer, upper lid depression is treated with lipoinjection, and lower lid retraction is treated with an auricular cartilage graft. From 1992 to 2004, 18 acquired anophthalmic orbits (11 enucleated and seven exenterated) were treated at Kobe University Hospital based on the authors' therapeutic strategy. Aesthetic outcomes were evaluated according to patient and surgeon satisfaction. Sixteen patients underwent auricular cartilage grafts, eight received radial forearm free flap transfers, and seven were treated with lipoinjection. Optional revisional surgery was carried out in four cases. The aesthetic outcome was assessed as good in six patients, moderate in eight patients, and poor in four patients; the last four had undergone total maxillectomy with orbital exenteration or had eyelid defects because of previous cancer surgery. The authors' therapeutic strategy for acquired anophthalmic orbit is simple and, with slight modification, fitting for most cases, although it necessitates innovative surgery in cases with orbital rim and/or eyelid defects.