En Bloc Resection of Lacrimal Sac Tumors and Simultaneous Orbital Reconstruction

Abstract

The combined sinus-orbit approach is an effective method of managing lacrimal sac tumors to achieve optimal tumor clearance from the orbit and nasal cavity. Simultaneous reconstruction of the bony defect with a contoured titanium mesh provides a fixation anchor for the medial canthal tendon and globe support and serves as a supporting platform for the lower eyelid and cheek to minimize midface collapse. Postoperative radiation is associated with skin flap breakdown and nasocutaneous fistula formation.

Clinical management and outcomes of lacrimal sac squamous cell carcinoma

“…In the past, orbital exenteration was frequently included in the therapeutic plan. In addition to the tumor, portions of the maxilla, lacrimal sac fossa, orbital rim, and facial soft tissue are resected . However, once a tumor extends beyond the lacrimal sac wall into the orbit, radical orbital exenteration does not improve prognosis .…”

“…In addition to the tumor, portions of the maxilla, lacrimal sac fossa, orbital rim, and facial soft tissue are resected. 12 However, once a tumor extends beyond the lacrimal sac wall into the orbit, radical orbital exenteration does not improve prognosis. 13 The most appropriate management of lacrimal sac tumors depends more on tumor size and the general condition of the patient.…”

Novel surgical approaches to the orbit

“…This technique, which uses the expertise of both a lacrimal surgeon and an otolaryngologist, allowed for tumor clearance of malignant lacrimal sac tumors (squamous cell carcinoma, adenoid cystic carcinoma, transitional cell carcinoma, mucoepidermoid carcinoma, and oncocytic adenoma), improved overall survival, and reduced disease relapse. 58 The procedure combined a medial orbitotomy with a medial maxillectomy (via a lateral rhinotomy skin incision) for en bloc resection of the tumor and reconstruction with a custom contoured titanium mesh for globe and eyelid support. 58 The reported complications were primarily related to the effects of postoperative radiation on wound healing including skin breakdown over the mesh with nasocutaneous fistula (9/14), medial canthal dystopia (2/14), and corneal perforation in a patient with recurrent disease (1/14).…”

“… 58 The procedure combined a medial orbitotomy with a medial maxillectomy (via a lateral rhinotomy skin incision) for en bloc resection of the tumor and reconstruction with a custom contoured titanium mesh for globe and eyelid support. 58 The reported complications were primarily related to the effects of postoperative radiation on wound healing including skin breakdown over the mesh with nasocutaneous fistula (9/14), medial canthal dystopia (2/14), and corneal perforation in a patient with recurrent disease (1/14). 58 Half of the patients also reported epiphora.…”

“… 58 The reported complications were primarily related to the effects of postoperative radiation on wound healing including skin breakdown over the mesh with nasocutaneous fistula (9/14), medial canthal dystopia (2/14), and corneal perforation in a patient with recurrent disease (1/14). 58 Half of the patients also reported epiphora. This may be a useful technique in patients with advanced or aggressive tumors.…”