Purpose: A proof-of-concept workflow study for the fabrication of custom orbital exenteration prostheses via automated noncontact scanning, 3D printing, and silicone casting. Design: Noncomparative, interventional case series. Methods: SETTING: Single-center institutional study. STUDY POPULATION: Three patients who have discontinued wearing of the ocularist-made exenteration prosthesis due to altered fit, discoloration, or material degradation. INTERVENTION PROCEDURE: A digital representation of the exenteration socket and contralateral periocular region was captured through noncontact facial topography mapping. Digital construction of the anterior prosthesis surface was based on the mirrored image of the contralateral side, and the posterior surface contour was based on orbital cavity geometry. The anterior and posterior surface details were digitally merged. A 2-piece mold was designed and produced in a 3D printer. Colorimetry was used to create a custom blend of pigments for incorporation into the Shore 40 silicone elastomer to generate a prosthesis that approximates the patient's skin tone. MAIN OUTCOME MEASURES: Prosthesis symmetry, skin tone match, comfort of wear, and appearance. Results: The first copy of every 3D-printed orbital prosthesis using this fabrication workflow produced good symmetry, color match, and prosthesis fit. In one case, the recontoured second copy with improved prosthesis edge-to-skin interface was made without the patient present. Conclusion: A noncontact 3D scanning, computer-aided design, 3D printing, and silicone casting for fabrication of orbital prosthesis was developed and validated. This production workflow has the potential to provide an efficient, standardized, reproducible exenteration prosthesis and to overcome the principal barriers to an affordable custom prosthesis worldwide: access and cost.
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