Orbital exenteration: an updated review with perspectives

Martel, Arnaud; Baillif, Stéphanie; Nahon-Estève, Sacha; Gastaud, Lauris; Bertolotto, Corine; Lassalle, Sandra; Lagier, Jacques; Hamédani, M.; Poissonnet, G.

doi:10.1016/j.survophthal.2021.01.008

Cited by 22 publications

(28 citation statements)

References 113 publications

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“…Reconstruction differs depending on the surgeon’s speciality and ranges from spontaneous granulation of the orbital socket to more complex and time-consuming free flaps [ 7 ]. Cosmetic rehabilitation is better achieved with an orbital prosthesis retained by orbital implants, skin glue or glasses [ 4 ]. Cosmetic rehabilitation depends on orbital socket healing and is often delayed, especially in the case of orbital implant placement [ 5 ].…”

Section: Orbital Exenteration For Locally Advanced Periocular Malignant Tumoursmentioning

confidence: 99%

“…Cosmetic rehabilitation depends on orbital socket healing and is often delayed, especially in the case of orbital implant placement [ 5 ]. Although recent progress has been made in terms of reconstructive strategies and cosmetic rehabilitation [ 4 ], OE is associated with anxiety and depression [ 8 ]. Periocular eyelid malignant tumours invading the orbit are the most common indication for OE [ 9 ].…”

Section: Orbital Exenteration For Locally Advanced Periocular Malignant Tumoursmentioning

confidence: 99%

“…Until recently, an eyelid malignancy invading the orbit was considered an indication for orbital exenteration (OE). However, OE is a radical, disfiguring and psychologically traumatic surgical procedure often refused by patients [ 4 ]. In addition, OE cannot be offered to one-eyed patients.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, several authors have tried to develop ‘eye-sparing’ strategies based on conservative surgical techniques followed or not by radiotherapy [ 2 ]. Although being attractive, conservative combined eyelid and orbital surgeries have been associated with several post-operative complications, limiting their interest [ 4 ]. In addition, several patients have experienced vision loss, and secondary eye amputation was sometimes required [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, several patients have experienced vision loss, and secondary eye amputation was sometimes required [ 2 , 3 ]. Therefore, a distinction between ‘eye-sparing’ and ‘sight-sparing’ strategies has emerged [ 4 ]. Over the last decade, targeted therapies such as anti-SMO (smoothened protein) therapies for the treatment of BCC have emerged as a viable strategy for locally advanced periocular malignant tumours.…”

Section: Introductionmentioning

confidence: 99%

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New Targeted Therapies and Immunotherapies for Locally Advanced Periocular Malignant Tumours: Towards a New ‘Eye-Sparing’ Paradigm?

Martel

Lassalle

Picard‐Gauci

et al. 2021

Cancers

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The management of periocular skin malignant tumours is challenging. Surgery remains the mainstay of treatment for localised eyelid cancers. For more locally advanced cancers, especially those invading the orbit, orbital exenteration has long been considered the gold standard; however, it is a highly disfiguring and traumatic surgery. The last two decades have been marked by the emergence of a new paradigm shift towards the use of ‘eye-sparing’ strategies. In the early 2000s, the first step consisted of performing wide conservative eyelid and orbital excisions. Multiple flaps and grafts were needed, as well as adjuvant radiotherapy in selected cases. Although being incredibly attractive, several limitations such as the inability to treat the more posteriorly located orbital lesions, as well as unbearable diplopia, eye pain and even secondary eye loss were identified. Therefore, surgeons should distinguish ‘eye-sparing’ from ‘sight-sparing’ strategies. The second step emerged over the last decade and was based on the development of targeted therapies and immunotherapies. Their advantages include their potential ability to treat almost all tumours, regardless of their locations, without performing complex surgeries. However, several limitations have been reported, including their side effects, the appearance of primary or secondary resistances, their price and the lack of consensus on treatment regimen and exact duration. The aim of this article was to review the evolution of the management of locally advanced periocular malignant tumours over the last three decades and highlight the new paradigm shift towards the use of ‘eye-sparing’ strategies.

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Section: Orbital Exenteration For Locally Advanced Periocular Malignant Tumoursmentioning

confidence: 99%

Section: Orbital Exenteration For Locally Advanced Periocular Malignant Tumoursmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

New Targeted Therapies and Immunotherapies for Locally Advanced Periocular Malignant Tumours: Towards a New ‘Eye-Sparing’ Paradigm?

Martel

Lassalle

Picard‐Gauci

et al. 2021

Cancers

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Extended orbital exenteration, epithetic restoration, and patient supply: A cross‐sectional study of a historic cohort

Ritschl,

Schwarz,

Klinger

et al. 2023

Head & Neck

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BackgroundThe aim of this study was to investigate the clinical course and to redefine an optimized algorithm for OE cases until epithetic restoration.MethodsIndication, defect type according to Kesting, reconstructive technique, incidence of postoperative complications and peri‐implantitis, patients' quality of life, timing of periorbital implant insertion, incidence of and interval to implant loss, and time until epithetic restoration were analyzed in 43 patients.ResultsA significant correlation was detected between wound dehiscence and defect type. Out of 24 patients, 7 were implanted secondarily with a median time interval of 399 days (270–2015) after OE. Eleven out of 83 placed implants were lost in 8 patients with a median time interval of 586 days (264–4485) after insertion. The majority of epithesis carriers had no or few restrictions in their quality of life.ConclusionsWe recommend our modified treatment algorithm to further improve and shorten the clinical course.

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Endoscopic‐assisted transorbital extended orbital exenteration: A multi‐institutional preclinical study

Roccuzzo,

Vyskocil,

Hirtler

et al. 2024

Head & Neck

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BackgroundSinonasal malignancies with orbital invasion have dismal prognosis even when treated with orbital exenteration (OE). Sugawara et al. developed a surgical strategy called “extended‐OE (EOE),” showing encouraging outcomes. We hypothesized that a similar resection is achievable under endoscopic guidance through the exenterated orbit (endoscopic‐EOE).MethodsThe study was conducted in three institutions: University of Vienna; Mayo Clinic; University of Insubria; 48 orbital dissections were performed. A questionnaire was developed to evaluate feasibility and safety of each step, scoring from 1 to 10, (“impossible” to “easy,” and “high risk” to “low risk,” respectively), most likely complication(s) were hypothesized.ResultsThe step‐by‐step technique is thoroughly described. The questionnaire was answered by 25 anterior skull base surgeons from six countries. Mean, median, range, and interquartile range of both feasibility and safety scores are reported.ConclusionsEndoscopic‐EOE is a challenging but feasible procedure. Clinical validation is required to assess real‐life outcomes.

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Orbital exenteration: an updated review with perspectives

Cited by 22 publications

References 113 publications

New Targeted Therapies and Immunotherapies for Locally Advanced Periocular Malignant Tumours: Towards a New ‘Eye-Sparing’ Paradigm?

New Targeted Therapies and Immunotherapies for Locally Advanced Periocular Malignant Tumours: Towards a New ‘Eye-Sparing’ Paradigm?

Extended orbital exenteration, epithetic restoration, and patient supply: A cross‐sectional study of a historic cohort

Endoscopic‐assisted transorbital extended orbital exenteration: A multi‐institutional preclinical study

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