A Large Retrospective Study on Long-Term Complications From Osseointegrated Orbitofacial Prosthetic Implants.

Abstract

Purpose: To evaluate long-term complications of osseointegrated orbitofacial prosthetic implantation following exenteration.

Methods: This retrospective review included 40 patients who received orbital reconstruction with osseointegrated orbitofacial prosthetics between 2008 and 2024. Patient demographics, exenteration indication, orbitofacial radiation exposure, osseointegration approach, and postoperative complications were recorded. Collection and evaluation of protected patient health information were Health Insurance Portability and Accountability Act compliant. This manuscript adheres to the tenets of the Declaration of Helsinki.

Results: A total of 134 implants were placed after orbital exenteration (average per orbit: 3). Most patients (75.0%, n = 30) had no implant failure/replacement within the follow-up period (range: 5 months to 16 years). Ten of the 134 placed implants failed (7.46%). Nine patients (22.5%) had an implant replaced within 5 years of implantation, and 1 patient (2.5%) had an implant replaced after 16 years. Implant failure was most often due to peri-implant bone instability (n = 6, 60.0%). Implants placed in the inferolateral orbital rim were most likely to fail (30%, n = 3). One failed implant (10%) was associated with a patient history of radiation treatment. General orbitofacial prosthetic discomfort (n = 22, 55%) was the most cited patient concern. Other common long-term complications included peri-implant discharge (n = 15, 37.5%), malodor (n = 15, 37.5%), and soft tissue dermatitis (n = 13, 32.5%).

Conclusions: There are long-term complications associated with osseointegrated orbitofacial prosthetics. There are practical perioperative and intraoperative opportunities to improve the outcome of osseointegrated orbitofacial prosthetic rehabilitation. Postoperative daily implant hygiene is critical for successful long-term rehabilitation.