Summary
Purpose
Orbital exenteration is a disfiguring procedure that results in a significant deformity
which poses a reconstructive challenge, especially in elderly patients with significant
comorbidities. We reviewed our experience of orbital exenteration.
Methods
A retrospective analysis was conducted identifying all patients undergoing orbital
exenteration over a 20-year period. Patient demographics, tumour characteristics and
reconstructive techniques used were recorded.
Results
Thirty-two patients were treated by orbital exenteration. The majority of these were
for basal cell carcinomas (53%). Most patients (62.5%) were ASA grade II or more.
Reconstructive techniques included split skin grafting (63%), forehead (25%), scalp
(6%) and cervicofacial (6%) flaps. Following reconstruction of the exenterated orbit,
29 patients had a prosthesis. Twenty-six of these rated their final result with their
definitive prosthesis as good.
Conclusions
Though there are various options available for reconstruction after orbital exenteration,
a split skin graft and orbital prosthesis provide a simple solution for a very difficult
problem of advanced periorbital skin cancer in the elderly population with significant
comorbidities. The final outcome is comparable to that of more complex flap reconstruction
with comparable satisfaction rates.
Keywords
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References
- Radical orbital resections.Adv Ophthalmic Plast Reconstr Surg. 1992; 9: 175-192
- Indications and surgical techniques for orbital exenteration.Adv Ophthalmic Plast Reconstr Surg. 1992; 9: 163-173
- Evisceration, enucleation, and exenteration.Otolaryngol Clin North Am. 1988; 21: 171-182
- Exenteration for benign orbital disease.Br J Ophthalmol. 1994; 78: 14-18
- Orbital exenteration: the reconstructive ladder.Ophthal Plast Reconstr Surg. 1991; 7: 84-92
- Exenteration of the orbit.Arch Ophthalmol. 1954; 51: 850-851
- Evaluation of 48 cases of orbital exenteration.Am J Ophthalmol. 1971; 72: 191-199
- Malignant tumours of the orbit and periorbital structures treated by exenteration.Plast Reconstr Surg. 1966; 37: 100-104
- Orbital exenteration at the Mayo clinic 1967–1986.Ophthalmology. 1989; 96: 468-471
- Incidence and treatment of dural exposure and CSF leak during orbital exenteration.Ophthal Plast Reconstr Surg. 1987; 3: 61-63
- A 20-year series of orbital exenteration.Am J Ophthalmol. 1991; 112: 496-501
- Survival after malignant tumours of the orbit and periorbit treated with exenteration.Acta Ophthalmol Scand. 1999; 77: 326-330
- Orbital exenteration: results of an individualized approach.Ophthal Plast Reconstr Surg. 2003; 19: 229-236
- Experience with eyelid sparing orbital exenteration: the 2000 Tullos O Coston lecture.Ophthal Plast Reconstr Surg. 2001; 17: 355-361
- Pattern of orbital exenteration in a tertiary eye care centre in India.Clin Experiment Ophthalmol. 2004; 32: 51-54
- Orbital exenteration: one size does not fit all.Am J Ophthalmol. 2005; 139: 11-17
- Orbital infiltration by eyelid skin carcinoma.Int Ophthalmol. 1990; 14: 285-294
- Orbital invasion by malignant eyelid tumours.Ophthal Plast Reconstr Surg. 1989; 5: 1-12
- Basal cell carcinoma of the eyelids and solar ultraviolet radiation exposure.Br J Ophthalmol. 1998; 82: 1412-1415
- Clinical characteristics associated with orbital invasion of cutaneous basal cell and squamous cell tumours of the eyelid.Am J Ophthalmol. 1992; 113: 123-133
- Basal cell carcinoma on the eyelids: own experience.Dermatol Surg. 2004; 30: 257-263
- Orbital exenteration in 95 cases of primary conjunctival malignant melanoma.Br J Ophthalmol. 1994; 78: 520-528
- Sebaceous carcinoma of the eyelid: a review of 14 cases.Dermatol Surg. 2004; 30: 1164-1168
- Sebaceous carcinoma of the eyelids: personal experience with 60 cases.Ophthalmology. 2004; 111: 2151-2157
- Squamous cell carcinoma of the eyelids.Br J Ophthalmol. 2002; 86: 1161-1165
- Orbital exenteration with spontaneous granulation.Arch Ophthalmol. 1986; 104: 139-140
- Primary skin grafting after exenteration of the orbit.Br J Plast Surg. 1958; 11: 57-61
- Use of autogenous split-thickness dermal graft for reconstruction after subtotal exenteration.Am J Ophthalmol. 1985; 100: 465-467
- Dermis fat graft for orbital reconstruction after subtotal exenteration.Am J Ophthalmol. 1986; 102: 228-236
- Exenteration of the orbit with transplantation of the temporalis muscle.Am J Ophthalmol. 1958; 45: 386-390
- Orbital reconstruction after exenteration: use of a transorbital temporal muscle flap.Ann Plast Surg. 2003; 50: 38-42
- Reverse temporalis muscle flap for the reconstruction of orbital exenteration defects.Ann Plast Surg. 2002; 48: 521-527
- The cervicofacial flap.Br J Plast Surg. 1988; 41: 470-474
- Reconstruction of the orbit after radical exenteration.Plast Reconstr Surg. 1970; 45: 119-123
- Midline forehead flap in reconstructive procedures of the eyelids and exenterated socket.Ophthalmic Surg. 1981; 12: 257-268
- Eye socket and eyelid reconstruction using combined island frontal flap and retroauricular island flap: a preliminary report.Ann Plast Surg. 1988; 20: 244-248
- Forehead flap periorbital reconstruction.Arch Facial Plast Surg. 2004; 6: 222-227
- Reconstruction with rectus abdominis myocutaneous free flap after orbital exenteration in children.Arch Ophthalmol. 2001; 119: 1705-1709
- Reconstruction of orbital exenteration cavities. The use of the latissimus dorsi myocutaneous free flap.Arch Ophthalmol. 1989; 107: 1681-1683
- Eye socket reconstruction with free radial forearm flap.Ann Plast Surg. 1989; 23: 112-116
- The role of free tissue transfer in reconstruction of massive neglected skin cancers of the head and neck.Arch Facial Plast Surg. 2003; 5: 479-482
- Current techniques of enucleation: a survey of 5439 intraorbital implants and a review of the literature.Ophthal Plast Reconstr Surg. 1995; 11: 77-88
- The osseointegration technique for the rehabilitation of the exenterated orbit.Arch Ophthalmol. 1991; 109: 1032-1038
Article info
Publication history
Published online: April 14, 2007
Accepted:
February 19,
2007
Received:
July 18,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
