Rehabilitation of the exenterated orbit

• Orbital exenteration, is a radical procedure consisting of removal of the orbital contents, including orbital fat, conjunctival sac, globe, and part or all of the eyelids • Since orbital exenteration is a psychologically and anatomically disfiguring procedure, some modifications of that, such as eyelid sparing techniques, retention of conjunctiva, and preservation of the periorbita have been introduced to aid in facial rehabilitation • Orbital exenteration is reserved for the treatment of potentially life threatening malignancies or relentlessly progressive conditions unresponsive to other treatments • Cosmetic reconstruction is a challenge. Satisfactory reconstructive results for both the physician and the patient may need multistage operations that are often time consuming and disfiguring. • Since the detection of recurrent disease is one of the main goal of the reconstruction, the healing by granulation of the exenterated orbit can be indicated allowing the visualization of the cavity. • A variety of techniques have been described for replacing orbital contents and eyelid in order to make the patient able to wear a prosthesis. The eye socket has been augmented by using dermal fat graft, cartilage graft, bone graft, artificial materials, local flap, or free flap. Conventional eyelid reconstruction techniques use local facial skin flaps. • All the above mentioned techniques could be suitable in rehabilitation of the exenterated orbit.. However, complications and disadvantages were demontsrated for every technique, therefore, the choice is based on the own experience of the surgeon. • In this chapter it will be presented a new procedure based on the use of midline forhead flap with a modified technique. This is a procedure developed by the authors • When the surgical reconstruction of the exenterated orbit provides poor aesthetic results and even more when a complex midfacial structures involvement occurs, the use of oculofacial prosthesis is indicated. In the last years the use of the oculofacial prosthesis has became wider. Implants and technology have been permanently improved and their use has expanded considerably.