Orbital exenteration

• Published in: Revue de stomatologie et de chirurgie maxillo-faciale Vol. 112; no. 2; pp. 69 - 74
• Main Authors: Benazzou, S, Arkha, Y, Boulaadas, M, Essakalli, L, Kzadri, M
• Format: Journal Article
• Language: French
• Published: France 01-04-2011
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell - secondary; Carcinoma, Basal Cell - surgery; Dentistry; Eyelid Neoplasms - surgery; Female; Follow-Up Studies; Graft Survival; Humans; Male; Middle Aged; Muscle, Skeletal - transplantation; Neoplasm Invasiveness; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Orbit Evisceration - methods; Orbital Neoplasms - surgery; Radiotherapy, Adjuvant; Reconstructive Surgical Procedures - methods; Retrospective Studies; Skin Transplantation - methods; Surgical Flaps; Survival Rate; Temporal Muscle - transplantation; Wound Healing - physiology
• ISSN: 1776-257X
• DOI: 10.1016/j.stomax.2011.01.003

Orbital exenteration is a disfiguring surgery. The surgery is mostly performed for advanced neoplasms of the eyelid in an attempt to achieve cure with tumor free margins. Reconstruction is a real challenge, especially in elderly patients with significant comorbidities.
We operated 15 patients presenting with palpebral and orbital tumors, between January 2000 and December 2007. We collected the clinical data concerning patients, tumor, treatment, and recurrences.
Ten male and five female patients with a mean age of 56 years at diagnosis presented with ulcerative palpebral malignant tumor, and impaired ocular motility. Basal cell carcinoma was the most common (80%). All patients underwent exenteration, (subtotal three, total eight, and extended four patients). The cavity was filled with a temporal muscle flap in ten cases, Mustardé flap in three cases, latissimus dorsi myocutaneous free flap in one case, and a jugal V-Y flap in one case. The mean follow-up was 23 months with good healing without radiotherapy tissue alteration. Four patients had a recurrence and one patient died from metastases.
The goals of reconstruction are functional and esthetic. Given the initial tumoral extension, we choose to use a regional or microsurgical flap for functional reconstruction. The flap provides a good cutaneous coverage, rapid healing, closure of orbital nasal and sinus communications, or of orbital and cranial communications. It is not damaged by radiotherapy.