BACKGROUND:
Management of congenital and acquired micro and anophtalmos in the pediatric patients is a challenging clinical problem for plastic and craniofacial surgeons. The absence of a normal size ocular globe during the period of facial growth has been associated with facial asymmetries that are difficult to reconstruct at later stages. Current surgical approaches based on the use of orbital spacers, expanding hydrogels, etc., remain as imperfect tools. Previous studies in our laboratory have shown that pressure controlled intra-orbital spherical tissue expanders promotes development of near normal orbits, ipsilateral facial bones and soft tissues in the anophtalmic in vivo kitten animal model. We hypothesize that the use of a similar orbital tissue expansion technique in pediatric patients with micro and anophthalmos would allow developing a near normal affected orbit and ipsilateral facial bones and facial soft tissues
METHODS:
Animal experiments and clinical trials were approved previously by institutional IRB committees. 10 pediatric patients with unilateral micro or anophtalmos of different origin, ages ranging between 2 to 7 year-old, were included in the study. Patients with microphtalmos underwent surgical removal of the atrophic ocular globe. Patients were implanted a 5ml spherical tissue expander (STE) in the affected orbit. STE was kept in place by closing both upper and lower lid conjunctiva with absorbablelvable suture. Peripheral access port was placed in the subcutaneous tissue of the ipsilateral temporal area. STE were expanded gradually approximately every 6 months to reach a final volume of 5-6 ml. Orbital dimensions were measured clinically with calipers and radiologicaly with CT scans yearly. STE were left in place between 3 and 12 years. Upon removal of the STE, a permanent ocular prosthesis was placed. Additionally blepharoplasty of the affected side was performed if necessary.
RESULTS:
Clinical radiological affected orbit growth curves showed an orbital growth similar to the contralateral unaffected side. Peri-orbital facial bones (zygomatic arch, etc) showed a normal growth pattern and were similar the contralateral unaffected side. No orbital tissue expander extrusion was observed in any of the patients.
CONCLUSIONS:
Congenital and acquired micro and anophtalmos in the pediatric patients is known to be associated with development of facial asymmetries that are difficult to treat at late stages. Our prospective clinical study, based on previous in vivo animal studies data, suggest orbital atrophy and ipsilateral bone and soft tissue facial symmetry may be prevented in micro and anophtalmic pediatric patients with the use of pressure-controlled intra-orbital tissue expanders.