The outcome of oral mucosal grafts to the orbit: a three-and-a-half-year study

A 3 1/2 year audit of the outcome of oral mucosal grafts was conducted at the occuloplastic service of Wentworth Hospital, Durban, South Africa. We studied 17 consecutive patients with ages ranging from 2 years to 83 years; young males predominated. The causative pathologies included six gunshot wounds, three retinoblastomas, two congenital abnormalities, two childhood traumas, a chemical burn, an occular pemphigoid, a stab wound and a firework injury. We treated 14 patients for a contracted socket, and performed mucosal grafts to the globe in the other three. Prostheses were successfully fitted in 12 of the patients with a contracted socket and in one patient with microphthalmia. Of the former patients, 10 had a good result and two had a fair result. Out of the 14 patients with a contracted socket, 10 required a repeat procedure. An onlay prosthesis was used instead of an inlay prosthesis in one patient because of the child's social circumstances; one patient was lost to follow-up. During the first year of the study, a thermoplastic conformer of Stent's composition was used. This was later changed to a plug of medicated paraffin gauze, which was easier to use. A permanent prosthesis was fitted 1 week postoperatively. The crucial factor for success was that there should be no delay between removing the plug and inserting the prosthesis. A single-stage reconstruction of the orbital wall and socket using costal cartilage and temporalis fascia together with an oral mucosal graft is discussed for reconstruction following gunshot wounds or retinoblastoma enucleation and radiotherapy. Oral mucosal grafts can be used successfully to reconstruct the conjunctiva on the globe and in the fornices.