 The
spherical configuration is used to expand the tissue of the
deep bony orbit. This sphere represents the shape of the natural
globe and is ideally suited to expand the deep orbital space.
The spheres are also available in three sizes to provide
multiple options for each individual case and to stage the
expansion program if necessary.
Orbit Expansion Techniques
The ability to expand the socket and the palpebral fissure
to the desired size and appearance may be limited by the bony
tissues of the orbit. In this case a sphere is used.
The insertion technique consists of placing expanding spheres
deep within the orbital tissues. It may be inserted in the
same fashion as a standard orbital implant. Care must be taken
to completely close the insertion incision. The incision should
be closed with a secure technique to compensate for the forces
of expansion.
In addition, a temporal incision may also be used. A temporal
incision in made to enable the subcutaneous insertion of a
dry sphere. A passage for the expander is prepared with blunt
dissection to the deep orbit. The dry sphere may then be worked
around the orbital rim and back into the orbit. The advantage
of this technique is the incision site is isolated from the
area of tissue expansion.
Exchange of Orbit Expander
Exchanging the orbit expander for a larger size may be necessary
as the child grows.
The procedure is similar to the initial implantation. The
expander may be aspirated through a small incision in the
dorsal conjunctiva. Osmotic tissue expanders consist of a
soft gel when fully hydrated and can be broken into small
particles; these particles may be removed with sterile saline
solution irrigation.
The socket will have a hollow capsular sack. It is important
to remove all remaining particles and make relaxing incisions
in this capsular sack to accommodate the increase in volume
with the subsequently larger expander. The incision in the
dorsal conjunctiva may be enlarged to accommodate the subsequently
larger expander.
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