This systematic review was aimed at gathering technical and clinical applications of CAD/CAM technology for the preoperative planning of craniofacial implants placement, designing of molds and substructures and fabrication of orbital prostheses. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, an electronic search was executed. Human studies that utilized digital planning systems for the prosthetic rehabilitation of orbital defects were included. A total of 16 studies of 30 clinical cases, which were virtually planned through various digital planning and designing software, were included. The most common preoperative data required for digital planning were CT scans in 15 cases, the 3DSS-STD-II scanning system in 5 cases, an Artec Color 3D scanner in 3 cases and a NextEngine Desktop 3D laser scanner in 2 cases. Meanwhile, the digital designing software were Ease Orbital Implant Planning EOIPlan software in eight cases, Geomagic software in eight cases, Simplant software in four cases and Artec Studio 12 Professional in three cases. Surgical templates were fabricated for 12 cases to place 41 craniofacial implants in the orbital defect area. An image-guided surgical navigation system was utilized for the placement of five orbital implants in two cases. Digital designing and printing systems were reported for the preoperative planning of craniofacial implants placement, designing of molds and substructures and fabrication of orbital prostheses. The studies concluded that the digital planning, designing and fabrication of orbital prostheses reduce the clinical and laboratory times, reduces patient visits and provide a satisfactory outcome; however, technical skills and equipment costs are posing limitations on the use of these digital systems.

OBJECTIVE: To describe clinical and histopathologic pre-operative diagnoses as well as associated post-operative complications following orbital silicone implantation in dogs undergoing enucleation and evaluate owner satisfaction.
METHODS: One hundred and eighty-six dogs who underwent enucleation with orbital implant.
METHODS: Medical records from dogs that underwent enucleation with orbital implant performed at Virginia-Maryland Veterinary Teaching Hospital between 2007 and 2019 were reviewed. Owners were surveyed via telephone regarding client satisfaction.
RESULTS: Enucleation followed by orbital implant placement occurred in 215 eyes of 186 dogs. The most common pre-operative diagnoses were glaucoma (68.8%), uveitis (17.7%), cataracts (15.8%), intraocular neoplasia (13.0%), and lens luxation (10.7%). The most common histopathologic diagnoses were retinal degeneration (46.5%), uveitis (39.5%), cataract (29.8%), retinal detachment (27.4%), and secondary glaucoma (26.5%). Fourteen eyes (6.5%) from ten dogs had post-operative complications reported including orbit cellulitis (n = 11), implant migration (n = 1), and implant extrusion (n = 1). Five of these dogs (50%) had concurrent diabetes mellitus. Median complication time from surgery was 41 days (range: 11-541 days). Ninety-five owner survey responses were completed with a median time of 6.3 years following surgery. Most owners, 85.3% (n = 81), were satisfied with the post-operative outcome.
CONCLUSIONS: Enucleation with implantation of an orbital implant is a viable and safe method for irreversibly blind eyes. Diabetes mellitus may be a risk factor for the development of post-operative complications. Intraocular neoplasia was not associated with development of post-operative complications. Results of this study indicated high owner satisfaction rates for improving cosmetic appearance after enucleation in dogs.

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OBJECTIVE: To determine the changes in indications for orbital exenteration over 20 years and to assess its impact on patient survival. Evolving techniques of rehabilitation of the orbit in our institution were also evaluated.
METHODS: This was a retrospective review of hospital records of patients who underwent orbital exenteration from 1995 to 2015 in a tertiary care center. Data extracted included primary location of the tumor, preoperative treatments, interval between initial diagnosis and exenteration, status of surgical margins, presence of metastatic disease, and postoperative survival. The types of prosthesis utilized over the years were also reviewed. Cox regression analysis was performed for categorical variables. Kaplan-Meier analysis was used to estimate post-exenteration survival.
RESULTS: Over a 20-year period, orbital exenteration was performed on 100 orbits of 100 patients. The mean age was 39.4 years (range: 2 months to 90 years). The most common indications among 98 malignant causes were retinoblastoma, squamous cell carcinoma, basal cell carcinoma, extraocular extension of uveal melanoma, and conjunctival melanoma. Postoperative survival was significantly related to age and tumor location but independent from gender, surgical margin, histopathological diagnosis, previous treatment modality, and preoperative interval. In the whole cohort, 1-year and 5-year survival rates were 97% and 84%, respectively.
CONCLUSIONS: Exenteration appears to be life-saving in children with orbital extension of retinoblastoma. While patients exenterated for malignant eyelid tumors have the best chance of survival, those with orbital extension of uveal melanoma and adenoid cystic carcinoma of the lacrimal gland have the worst prognosis.

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In this paper, a computer-aided system for orbital prosthesis rehabilitation is introduced. With the system, a 3D model of the orbital prosthesis can be easily reconstructed from the CT image of a patient by referring to the normal eye of the patient, and the rehabilitation result by the model can be simulated before the surgery. This facilitates surgeons to design appropriate orbital prosthesis and improve rehabilitation esthetics. Based on the system, the preoperative surgery planning for orbital implant can also be made. This improves the reliability, safety and intuition of the rehabilitation surgery well. The system has been applied to clinical CT images of patients, and the experimental results show effectiveness and acceptability of the system in the clinic.

Restoration of orbital defects with silicone prosthesis has been a well-documented and accepted treatment option. Adhesive retained prosthesis offer the patients with adequate retention and treatment satisfaction. However, marginal breakdown and discoloration are common problems associated with these prostheses, necessitating their refabrication. Fabrication of a silicone orbital prosthesis is time consuming and requires multiple clinical and laboratory procedures. This technical article describes simple and cost effective steps for rapid fabrication of a silicone prosthesis using conventional methods.

Diminution of the orbital contents post-surgical removal of a malignant tumor can have a severe psychological impact on the patient in terms of function and esthetics. Therefore, esthetic remedy should be planned subsequently, since tumor obliteration precedes cosmetic concern. A convenient option for successful rehabilitation in such patients is a simple, user-friendly, removable orbital prosthesis. Retention of the prosthesis is one of the key factors for the successful rehabilitation. Spectacle frame, conformers, adhesives, osseointegrated implants, magnets or buttons have been used to impart retention to the prosthesis. The use of semi precision attachments in maxillofacial prostheses is limited to the osseointegrated prostheses. This case report describes a conventional spectacle frame technique, to retain the silicone orbital prosthesis using two different types of stud attachments viz., dalla bona and O-ring attachment systems.

The Tessier number 5 cleft is a rare craniofacial anomaly. Although there are case reports outlining various methods of primary surgical repair and outcomes, few cases reveal long-term follow-up or discuss secondary reconstruction. This article presents the case of a man born with a unilateral Tessier number 5 cleft who presented to our institution at the age of 41 after more than 25 previous surgeries. Over the course of 11 years, he had several surgeries including an orbital repositioning through a combined intra- and extracranial approach, an orbital enucleation, and an anterolateral thigh flap. The patient was fitted with an orbital prosthesis and a satisfactory aesthetic result was achieved.

This report describes a different approach for diminishing the movements of orbital prosthesis during mimic movements and chewing function. Mechanical devices such as magnets are used to enhance the retention in case lack of the implants. However rigid fixation of obturator and orbital prosthesis can result in movements of the orbital prosthesis during mastication. In this case obturator and orbital prosthesis are combined by magnets. However this combination is not rigid because of an active part which provides movement. This active part allows movements in a space constructed in the acrylic base of orbital prosthesis. Thus, the movements that may occur on orbital prosthesis during chewing can be diminished by this simple mechanism. Due to the fact that designing such a mechanism that minimizes the movements of the orbital prosthesis contributes patient\'s comfort.