A challenging journey of maxillofacial implants placement and rehabilitation in an irradiated exenterated socket

Rehabilitation of a post-exenterated orbital defect is a necessity, to restore a patient's esthetic appearance and help overcome the associated psychosocial stigma. An implant supported prosthesis enjoys a better patient acceptance due to its superior retention and stability. This clinical report highlights the challenges faced in planning, designing and placement of maxillofacial implants in the supra-orbital rim of an exenterated socket post-radiotherapy along with the management of the unexpected complications which developed subsequently. Administration of hyperbaric oxygen therapy, fabrication of a digitally designed surgical guide to ensure predictable implant placement, selection of surface treated implants for better biomechanical anchorage, and a gentler surgical technique for recovery of irradiated hard and soft tissues were measures undertaken during the treatment phase. An effort has been made to point-out the fact that despite the various approaches adopted in an irradiated patient, success of implant placement in such a situation remains a challenge.