Orbital exenteration: One size does not fit all

Simon, Guy J. Ben; Schwarcz, Robert; Douglas, Raymond S.; Fiaschetti, Danica; McCann, John D.; Goldberg, Robert A.

doi:10.1016/j.ajo.2004.07.041

Cited by 117 publications

(95 citation statements)

References 29 publications

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“…1,4,6,7 The remainder originate almost exclusively in the conjunctiva, orbit, or globe. Tumours arising in the paranasal sinuses and nose may also require exenteration to achieve local control, but these tumours usually do not present to an ophthalmologist.…”

Section: Indicationsmentioning

confidence: 99%

“…22,23,29 Spread through the periorbita into bone has been reported in 20-30% of cases. 4,23 Perineural spread is also asymptomatic in the early stages, but eventually results in numbness or, less frequently, pain in the distribution of the trigeminal nerveFespecially the supraorbital nerve in periocular tumours. Branches of the facial nerve are also frequently involved.…”

Section: Indicationsmentioning

confidence: 99%

“…3,4,36 Frequent dressings with antibacterial packs are needed. Healing by granulation results in a shallower socket than with split skin grafting.…”

Section: Management Of the Exenterated Orbit Without Lid Sparingmentioning

confidence: 99%

“…Lid sparing exenteration 1,3,4 Incisions are made 1 mm from the lashes in the upper and lower lids. Dissection is preferably deep to the orbicularis muscle, but it can be at a more superficial level between the skin and orbicularis muscle if tumour clearance would be compromised by a deeper level of dissection.…”

Section: Management Of the Exenterated Orbit Without Lid Sparingmentioning

confidence: 99%

“…'Total' exenteration as defined above is often needed, but when possible, orbital tissue is conserved and eyelid skin and orbicularis muscle are spared to aid healing. 1,3,4 If the bone of the orbit is invaded, an 'extended' exenteration is required that includes resection of diseased bone. 4,5 …”

Section: Introductionmentioning

confidence: 99%

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Orbital exenteration for invasive skin tumours

Tyers

2006

Eye

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Orbital exenteration aims at local control of disease invading the orbit that is potentially fatal or relentlessly progressive. Of all exenterations presenting to ophthalmologists, 40-50% are required for tumours in the eyelid or periocular skin. 99% of these are basal cell carcinomas and 4-6% each are squamous cell carcinomas or sebaceous gland carcinomas. Orbital invasion results in progressive fixation of the tumour to bone and reduced ocular motility. Perineural invasion of branches of the trigeminal nerve leads to numbness or pain, and that the facial nerve, to weakness. Biopsy identifies the cell type and the presence of perineural invasion. CT and MRI scanning help in the assessment of tumour spread within the orbit. Management should be in collaboration with an oncologist. Exenteration may be totalthe removal of all orbital contents-or lidsparing if the tumour is placed posteriorly. The socket may be allowed to heal by granulation or lined with a split skin graft or local flap. Complications may be seen following 20-25% of exenterations and include fistulae, tissue necrosis, exposed bone, and infection. Incomplete clearance of tumours occurs in about 38% of total exenterations and 17% of subtotal. The overall 5-year survival is 55-65%, but significantly worse if there was perineural spread. Facial prostheses may be mounted on glasses or secured with tissue glue or osseointegrated implants. Excellent cosmetic results can be achieved but many patients prefer to wear a patch.

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Section: Indicationsmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

“…3,4,36 Frequent dressings with antibacterial packs are needed. Healing by granulation results in a shallower socket than with split skin grafting.…”

Section: Management Of the Exenterated Orbit Without Lid Sparingmentioning

confidence: 99%

Section: Management Of the Exenterated Orbit Without Lid Sparingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Orbital exenteration for invasive skin tumours

Tyers

2006

Eye

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Outcomes of orbital exenteration for craniofacial lesions

Traylor

Christiano

Esmaeli

et al. 2021

Cancer

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BACKGROUND Orbital exenteration (OE) is an ablative procedure used in the management of malignancies of the orbit of either primary or secondary origin. Publications evaluating this procedure have suffered from small patient numbers, heterogeneity of pathologies, and poor patient follow‐up. The purpose of this study was to assess patient outcomes in a large cohort of patients undergoing OE at a tertiary cancer center. METHODS A retrospective review was conducted of 180 consecutive patients who underwent OE at the authors' institution. Overall survival (OS) was the primary end point measured in the study. Time to locoregional recurrence (progression‐free survival [PFS]) and disease‐free survival were secondary end points. RESULTS Between the years 1993 and 2011, 180 consecutive patients received OE for craniofacial malignancy at the authors' institution. The median follow‐up for the cohort was 9.7 years (116 months). The median OS was 73 months, and the median PFS was 96 months. The presence of perineural invasion was associated with shorter OS (P = .01) and PFS (P < .01). Magnetic resonance imaging was predictive of perineural invasion (P < .01). Positive margins were associated with shorter PFS than negative margins (P < .01) but with no change in OS (P = .15). The overall complication rate was 15%. The major complication rate (Clavien‐Dindo 3b or greater) was 2.8% (n = 5), and there was 1 death observed (0.6%). CONCLUSIONS Used judiciously in the setting of a multidisciplinary management plan, OE for tumor control is a safe therapy. LAY SUMMARY Between the years 1993 and 2011, 180 consecutive patients received orbital exenteration for craniofacial malignancy at the MD Anderson Cancer Center. The median follow‐up for the cohort was 9.7 years. The presence of perineural invasion was associated with shorter overall survival (P = .01) and progression‐free survival (P < .01). Magnetic resonance imaging was predictive of perineural invasion (P < .01). Positive margins were associated with shorter progression‐free survival than negative margins (P < .01). The overall complication rate was 15%. The major complication rate (Clavien‐Dindo 3b or greater) was 2.8% (n = 5).

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Orbital Exenteration and Rehabilitation of the Exenterated Socket

Hsu

Hanasono

2010

Ophthalmic Oncology

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Orbital exenteration: One size does not fit all

Cited by 117 publications

References 29 publications

Orbital exenteration for invasive skin tumours

Orbital exenteration for invasive skin tumours

Outcomes of orbital exenteration for craniofacial lesions

Orbital Exenteration and Rehabilitation of the Exenterated Socket

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