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An Age-Related Algorithm for Management of Micro-Orbitism from Anophthalmia
Brandon J. De Ruiter, BS1; Robert P. Lesko, BA1; George Kamel, MD1; Jinesh Shah, MD1; Anne Barmettler, MD2; Anand R. Kumar, MD, FACS, FAAP3; Edward H. Davidson, MD3;
1Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New Yor
2020-01-30
Presenter: Brandon J De Ruiter
Affidavit:
I certify that the information enclosed here is the original work of the authors. All authors have reviewed the submitted work to ensure accuracy.
Director Name: Edward H. Davidson
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND
Pediatric anophthalmia is a rare disfiguring condition that poses unique reconstructive challenges. While skeletal growth must be addressed to avoid micro-orbitism, the efficacy and safety of treatment options varies with age. Bony changes are recalcitrant to implants in those at skeletal-maturity and osteotomies grow technically challenging following frontal-sinus pneumatization. This study reviews treatment methods and presents an age-based-treatment-approach.
METHODS
A systematic literature review was conducted searching PubMed, Embase, and Web-of-Science databases. Relevant English-language primary-literature was included. Information on sample-size, interventions, age, complications, and prosthetic retention was obtained. Preliminary cases demonstrating treatment of anophthalmia in those at skeletal-maturity are presented and corroborated with literature review findings.
RESULTS
566 studies were obtained on initial search, 198 subjected to full-text review, and 35 included for analysis. 399 patients with 437 anophthalmic orbits are reported. Interventions included osteotomies (22.9%), inflatable-expanders (22.9%), osmotic-expanders (14.3%), distraction-osteogenesis (8.6%), dermis-fat-grafts (5.7%), bone-grafts (5.7%), custom-devices (2.9%), and multiple-interventions (8.6%). Dermis-fat-grafts were successful until 4yrs after which graft atrophy (21%) limited effect. Inflatable, osmotic, and solid implants were effective until ages 2.6yrs (range 4mo–9yrs), 2.3yrs (2mo–10yrs), and 1yr (birth–2.4yrs) respectively. Overall, prosthetic retention was optimized with minimal complications in those 0-4yrs managed with dermis-fat grafts, 5-7yrs with implants, and 8+yrs with osteotomies or onlay prosthetics (depending on bone-stock/frontal-sinus pneumatization). Representative cases, including an eight-year-old treated with box-osteotomy and thirteen-year-old with PEEK prosthetic, corroborated review findings and supported the proposed age-based approach.
CONCLUSIONS
Treatment of pediatric anophthalmia must be tailored to skeletal age to optimize outcomes.
