Repair of orbital implants exposures using muller muscle flaps

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Abstract

Purpose

To evaluate a two-stage technique of Müller muscle and conjunctival flap for treatment of orbital implant exposure defects.

Methods

In this retrospective study, 19 patients with acquired anophthalmic socket presenting an exposure of orbital implant were included, between March 1999 and September 2012.

Results

13 women, 6 males were managed with this two-stage procedure. Medium age was 57.5 years (9 to 90). The average follow-up was 41 months (3 to 163). 16 patients underwent an evisceration and 3 patients an enucleation. All of them were implanted primarily with hydroxyapatite (HA) implants, except one of them who had an acrylic implant. Orbital implant exposure was note at an average of 94.4 months (2 to 240) after implantation. The average period between the first-stage (Müller muscle flap) and the second-stage (section of the flap) was 39.9 days. Success rate was 68.4% (13 patients) and the failure rate was 31.6% (6 patients) who required second surgery (one or two-stage implant ablation followed by dermis fat graft, or temporalis fascia graft). Predisposing factors for exposure were noticed among patients with failed Müller muscle flaps: 2 underwent an enucleation for melanoma followed by radiation therapy, 1 patient had an acrylic non porous implant. 1 patient presented an early exposure probably due to suture under stress. But 2 others patients did not present predisposing factors for exposure. Once the exposure was treated, all of the patients were fitted with a prosthetic device successfully.

Conclusion

Müller muscle flap 2-stage procedure is a reliable technique, with a success rate superior to 68%, allowing preservation of the implant and successful equipment with prosthetic devices.

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