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Post a Comment Development of schematic representations for globe removal and formation of the supporting-motor stump for use in ophthalmological and radiological practice
- Authors: Davydov D.V.1, Gridasova I.S.2, Serova N.S.2, Pavlova O.Y.2, Konovalov K.A.3
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Affiliations:
- P.A. Herzen Moscow Oncology Research Institute, branch of the National Medical Research Center of Radiology
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
- 1586 Military Clinical Hospital
- Issue: Vol 16, No 4 (2023)
- Pages: 43-53
- Section: Original researches
- URL: https://journals.rcsi.science/ov/article/view/254572
- DOI: https://doi.org/10.17816/OV623658
- ID: 254572
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Abstract
BACKGROUND: Today, the issue of globe endoprosthetics is an extremely important problem due to several reasons: the presence of various methods for globe removal, the variety of implants and surgical installation techniques, non-standard cavities before prosthetics, the lack of a unified algorithm for examining the patients at the pre- and postoperative stages, as well as difficulties in the rehabilitation of patients with anophthalmos and high aesthetics requirements.
AIM: Development of schematic images of performing various surgical techniques for globe removal and forming a supporting-motor stump for a cosmetic prosthesis.
MATERIALS AND METHODS: During 2020–2023, in different institutions, 43 patients (100%) were examined for globe endoprosthetics, from 18 to 65 years old, 23 men, 20 women. The authors analyzed CT data obtained at the radiological department No. 2 of Sechenov University and at the 1586 Military Clinical Hospital of the Russian Ministry of Defense.
RESULTS: All patients (n = 43; 100%) underwent a globe removal in various modifications depending on the initial condition, in 39 cases (78%) — reconstructive surgery for the endoprosthesis installation in order to form a volumetric supporting-motor stump, and further external cosmetic prosthetics. In 10 patients (22%), the endoprosthesis was installed after enucleation of the globe, in 33 (78%) — after evisceration in various modifications.
CONCLUSIONS: This paper presents schematic images of various techniques for surgical globe removal, formation of a supporting-motor stump, types of endoprostheses, the options of external cosmetic prosthetics and the presence of complications, as well as a CT protocol for the description of obtained images.
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##article.viewOnOriginalSite##About the authors
Dmitry V. Davydov
P.A. Herzen Moscow Oncology Research Institute, branch of the National Medical Research Center of Radiology
Email: d-davydov3@yandex.ru
ORCID iD: 0000-0002-8025-4830
SPIN-code: 1368-2453
MD, Dr. Sci. (Medicine), Professor
Russian Federation, MoscowIrina S. Gridasova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: dr.gridasova_irina@mail.ru
ORCID iD: 0009-0001-4851-3054
Russian Federation, Moscow
Nataliya S. Serova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: dr.serova@yandex.ru
ORCID iD: 0000-0003-2975-4431
SPIN-code: 4632-3235
Dr. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences
Russian Federation, MoscowOlga Yu. Pavlova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: pavlova_o_yu@staff.sechenov.ru
ORCID iD: 0000-0001-8898-3125
SPIN-code: 8326-0220
MD, Cand. Sci. (Medicine)
Russian Federation, 8/2 Trubetskaya st., Voscow, 119048Konstantin A. Konovalov
1586 Military Clinical Hospital
Author for correspondence.
Email: kkonovalov82@mail.ru
ORCID iD: 0000-0002-6880-0077
SPIN-code: 3604-0676
MD, Cand. Sci. (Medicine)
Russian Federation, MoscowReferences
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Fig. 1. Schematic representation of the normal orbital structure. The globe is round in shape, with clear, even contours, the lens is visualized. The optic nerve and recti extraocular muscles can be traced throughout their entire length, with clear, even contours. The density and structure of the orbital fat tissue is homogeneous. No additional masses, bone-traumatic or bone-destructive changes were identified
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Fig. 2. MSCT of the orbit, axial section, soft tissue reconstruction. Normal orbital structures. The globe is round in shape, with clear, even contours, the lens is visualized. The optic nerve and recti extraocular muscles can be traced throughout their entire length, with clear, even contours. The density and structure of orbital fat tissue is homogeneous, ranging approximately from –80 to –110 HU. No additional masses, bone-traumatic or bone-destructive changes were identified
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Fig. 3. Complete removal of the globe without simultaneous formation of a supporting-motor stump and without installation of an endoprosthesis. The remaining fragment of the optic nerve is present, contracted oculomotor muscles are visualized in the posterior section
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Fig. 4. The state after enucleation without the simultaneous formation of a supporting-motor stump and the installation of an endoprosthesis. The remaining fragment of the optic nerve is present, contracted extraocular muscles are stitched together in the middle part of the orbit
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Fig. 5. Condition after enucleation, neurectomy, formation of a supporting-motor stump: implantation of a spherical endoprosthesis, the extraocular muscles are connected to the endoprosthesis
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Fig. 6. The state after enucleation, neurectomy, formation of a supporting-motor stump: implantation of a spherical endoprosthesis, the extraocular muscles are stitched in front of the endoprosthesis
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Fig. 7. An external cosmetic prosthesis is installed in the conjunctival cavity, congruent with the anterior surface of the stump
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Fig. 8. MSCT of the orbit, axial section, bone reconstruction regimen. The state after enucleation of the right globe because of retinoblastoma without formation of a supporting-motor stump and installation of an endoprosthesis. In the anterior parts of the right orbit, an external cosmetic prosthesis is visualized with its prolapse into the orbital cavity, as well as the optic nerve stump and extraocular muscles
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Fig. 9. Evisceration technique with removal of the cornea without simultaneous formation of a supporting-motor stump and installation of an endoprosthesis. First stage: removal of the cornea
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Fig. 10. Evisceration technique with removal of the cornea without simultaneous formation of a supporting-motor stump and installation of an endoprosthesis. Second stage: the residual sclera (scleral sac) in a free state is visualized in the orbital cavity
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Fig. 11. Evisceration technique with removal of the cornea. Third stage: removal of the posterior pole of the sclera with neurectomy, installation of a spherical endoprosthesis
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Fig. 12. Evisceration technique with removal of the cornea with simultaneous formation of a supporting-motor stump and installation of an endoprosthesis. Stage four: installation of an external cosmetic prosthesis
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Fig. 13. MSCT of the orbit, axial section, soft tissue reconstruction. The state after evisceration of the right globe due to its injury. Evisceration technique with removal of the cornea without simultaneous formation of a supporting-motor stump and installation of an endoprosthesis. Second stage: in the orbital cavity, the residual sclera is visualized in a free state (arrow), the tortuous course of the optic nerve is visualized, recti extraocular muscles are noted, the inferior rectus muscle is thickened, prolapses into the region of the maxillary sinus; post-traumatic changes and defects of the orbital floor are visualized
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Fig. 14. Installation of a non-spherical endoprosthesis after complete globe removal without simultaneous formation of a supporting-motor stump. In the posterior section, contracted extraocular muscles and the optic nerve stump are visualized; in the anterior section, a non-spherical endoprosthesis is visualized
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Fig. 15. Installation of an external cosmetic prosthesis congruent with the supporting-motor stump after removal of the eyeball by enucleation
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Fig. 16. Installation of an external cosmetic prosthesis after globe removal using the evisceration method with removal of the cornea. The external cosmetic prosthesis is congruent with the surface of the endoprosthesis; there is no liquid or air vacuoles between them
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Fig. 17. MSCT of the orbit, axial section, soft tissue reconstruction mode. The state after endoprosthesis installation after evisceration of the right globe. In the anterior part of the right orbit, a centrally located endoprosthesis is visualized (red arrow), round in shape, with homogeneous structure, 20 mm in diameter, with an average density of +372 HU, no additional inclusions in the area of the prosthesis were identified, the endoprosthesis capsule with clear, even contours is visualized in the anterior part. An external cosmetic prosthesis is adjacent to the front surface of the endoprosthesis (green arrow). The orbital floor of the right orbit is reconstructed with a mesh implant, without any signs of bone-destructive changes
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Fig. 18. Installation of an external cosmetic prosthesis after globe removal with evisceration technique. The external cosmetic prosthesis is congruent with the surface of a supporting-motor stump, liquid content is noted between them
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Fig. 19. Installation of an external cosmetic prosthesis after globe removal with evisceration technique. Lack of congruence between the surfaces of a supporting-motor stump and the external cosmetic prosthesis
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Fig. 20. MSCT of the orbit: а — axial plane, bone window mode (assessment of the symmetry of the anterior contour of the external cosmetic prosthesis and the contralateral globe using a line drawn through the zygomatico-frontal sutures on both sides and perpendiculars to this line); b — axial plane, soft tissue window mode (assessment of the globe and endoprostheses size); c — coronal reconstruction, soft tissue window mode (assessment of the symmetry and size of recti extraocular muscles and the superior oblique muscle); d–f — axial planes, soft tissue window mode [d — assessment of the optic nerve stump and the distance from the stump to the endoprosthesis (arrow); e — assessment of the endoprosthesis capsule (arrow); f — assessment of the space between the external cosmetic prosthesis and the endoprosthesis (arrow)]
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Fig. 21. Eyeball endoprosthetics: a — schematic representation of orbital structures (Э — endoprosthesis, K — nerve stump, Н — external cosmetic prosthesis); b — MSCT of the orbit, sagittal reconstruction, soft tissue window mode, with intravenous contrast, state after endoprosthetics of the left globe. In the anterior part of the left orbit, a centrally located endoprosthesis is visualized (red arrow), round in shape, with homogeneous structure, of 20 mm in diameter, average density of –33 HU, no additional inclusions in the area of the prosthesis were identified, in the anterior part an endoprosthesis capsule with clear, even contours is visualized. An external cosmetic prosthesis (green arrow) is adjacent to the front surface of the endoprosthesis, with the presence of air vacuoles between them
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