Surgical coverage of exposed hydroxyapatite implant with retroauricular myoperiosteal graft

Abstract

Background: With the increasing use of hydroxyapatite orbital implants, the complication of exposure has become apparent to oculoplastic surgeons. Many kinds of patch grafts, such as sclera, dermis, and hard palate mucosa, have been used to cover exposed hydroxyapatite implants with inconsistent results. In this study, the authors use a newly developed technique, autogenous retroauricular myoperiosteal graft, and the results are reported. Methods: A piece of retroauricular muscle together with its underlying periosteum was carefully harvested. This myoperiosteal graft was patched to the debrided hydroxyapatite exposure area with the periosteal surface facing outward. The margin of periosteal surface was secured with conjunctiva and left uncovered for the surrounding conjunctiva to epithelialise. Results: Nine eyes with hydroxyapatite exposure more than 3 mm were managed with autogenous retroauricular myoperiosteal grafts. Seven cases were successfully treated with single graft surgery. The other two cases needed an additional graft surgery, and there was no re-exposure noted thereafter. Five patients received a successful insertion of the motility peg. All nine patients have been fitted with prosthesis with reasonable motility. There were no complication noted during more than 1 year of follow up. Conclusion: The thick composite nature of the myoperiosteal graft provides a durable and vascularised coverage for exposed hydroxyapatite implants. This technique offers an encouraging alternative for the management of exposed hydroxyapatite implants.

Remove, rotate, and reimplant: a novel technique for the management of exposed porous anophthalmic implants in eviscerated patients

“…1,2 They also permit drilling and peg insertion, and allow better prosthetic retention, movement, and cosmesis. 3,4 An extensive porous system, permitting fibrovascular ingrowth from adjacent orbital tissues, is thought to decrease the risk of implant extrusion and infection. 3,5 Paradoxically, implant exposure is the most frequent complication of porous implants reported in many series.…”

“…3,4 An extensive porous system, permitting fibrovascular ingrowth from adjacent orbital tissues, is thought to decrease the risk of implant extrusion and infection. 3,5 Paradoxically, implant exposure is the most frequent complication of porous implants reported in many series. 2,[5][6][7][8] The incidence of porous implant exposure in many studies varies from 0-34% with varying follow-up durations.…”

“…Endogeneous and exogeneous materials have been used for grafting. 3,4,9,[16][17][18][19][20] Porous implant exposure management, after evisceration, may necessitate removal of the porous implant from the scleral tissue that requires blunt and sharp dissection of the fibrovascular attachments, which is often a traumatic procedure for the orbital contents and the implant covering and is generally considered a difficult surgical task. The removed implant is exchanged with a new implant, which is then placed into the remaining sclera and the Tenon's capsule.…”

“…Management of porous sphere implant exposure includes two main graft techniques: those with exogenous material versus those with autogenous material. Risk of immunological reaction and infection is seen less in autogenous graft materials such as temporalis fascia, 4,16,17 dermis fat grafts, 9 retroauricular myoperiosteal graft, 3 frontal periosteal graft, 18 Mü ller muscle flap, 19 and implant capsule. 20 Exogenous scleral patch grafts carry the risk of transmission of slow virus infections.…”

Buccal mucosal graft for hydroxyapatite orbital implant exposure

“…A variety of tissue types has been used to cover the exposed area, including banked sclera, dermis fat grafts, hard palate mucosa, temporalis fascia, fascia lata, and retroauricular myoperiosteum [1][2][3]. Poor vascularization and graft melting have frequently been seen in cases where such graft materials were used [1].…”