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Roccuzzo G, Vyskocil E, Hirtler L, Kandathil SA, Peris-Celda M, Agosti E, Kuan EC, Wang EW, Leong S, Sharma R, Borsetto D, Herman P, Vinciguerra A, Verillaud B, Bresson D, Taboni S, Erovic BM, Vural A, Dallan I, Doglietto F, Schreiber A, Mattavelli D, Rampinelli V, Arosio AD, Battaglia P, Valentini M, Turri-Zanoni M, Pozzi F, Volpi L, Bignami M, Castelnuovo P, Nicolai P, Ferrari M. Endoscopic-assisted transorbital extended orbital exenteration: A multi-institutional preclinical study. Head Neck 2024. [PMID: 38958177 DOI: 10.1002/hed.27858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Sinonasal 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). METHODS The 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. RESULTS The 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. CONCLUSIONS Endoscopic-EOE is a challenging but feasible procedure. Clinical validation is required to assess real-life outcomes.
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Affiliation(s)
- Giuseppe Roccuzzo
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, Padova, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, Azienda Ospedale-Università Padova, Padova, Italy
- Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Erich Vyskocil
- Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Sam Augustine Kandathil
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | | | - Edoardo Agosti
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Edward C Kuan
- Department of Otolaryngology - Head & Neck Surgery, University of California Irvine, Irvine, California, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Samuel Leong
- Department of Ear, Nose and Throat, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rishi Sharma
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daniele Borsetto
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Philippe Herman
- Otorhinolaryngology and Skull Base Center, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Alessandro Vinciguerra
- Otorhinolaryngology and Skull Base Center, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Benjamin Verillaud
- Otorhinolaryngology and Skull Base Center, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Damien Bresson
- Department of Neurosurgery, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Stefano Taboni
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, Padova, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, Azienda Ospedale-Università Padova, Padova, Italy
| | - Boban M Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
| | - Alperen Vural
- Department of Otorhinolaryngology, Istanbul University Cerrahpasa - Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Iacopo Dallan
- Department of Otolaryngology - Head and Neck Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Doglietto
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Daniele Arosio
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Marco Valentini
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Fabio Pozzi
- Department of Neurosurgery, ASST Sette Laghi, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - Luca Volpi
- Department of Otolaryngology - Head and Neck Surgery, ASST Lariana, Ospedale Sant'Anna, University of Insubria, Como, Italy
| | - Maurizio Bignami
- Department of Otolaryngology - Head and Neck Surgery, ASST Lariana, Ospedale Sant'Anna, University of Insubria, Como, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Piero Nicolai
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, Padova, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, Azienda Ospedale-Università Padova, Padova, Italy
| | - Marco Ferrari
- Otolaryngology Section, Department of Neurosciences DNS, University of Padova, Padova, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, Azienda Ospedale-Università Padova, Padova, Italy
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Bottini GB, Joos V, Steiner C, Zeman-Kuhnert K, Gaggl A. Advances in Microvascular Reconstruction of the Orbit and Beyond: Considerations and a Checklist for Decision-Making. J Clin Med 2024; 13:2899. [PMID: 38792440 PMCID: PMC11122336 DOI: 10.3390/jcm13102899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
This paper aims to discuss the microvascular reconstruction of the orbit and adjacent regions and to propose a checklist to aid the reconstructive surgeon in this challenging undertaking. The discussion is based on a literature review that includes 32 retrospective case series, 5 case reports published in the last 34 years in PubMed, and 3 textbook chapters. Additionally, it relies on the senior author's expertise, described in a case series, and two case reports published elsewhere. Classifications and treatment algorithms on microvascular orbit reconstruction generally disregard patient-related factors. A more holistic approach can be advantageous: patient-related factors, such as age, comorbidities, prognosis, previous interventions, radiotherapy, and the wish for maximal dental rehabilitation and a prosthetic eye, have the same importance as defect-related considerations and can inform the choice of a reconstructive option. In this manuscript, we examine defect- and patient-related factors and new technologies, provide a checklist, and examine future directions. The checklist is intended as a tool to aid in the decision-making process when reconstructing the orbital region with microvascular flaps.
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Affiliation(s)
- Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Veronika Joos
- Private Practice for Dentistry and Oral and Maxillofacial Surgery, 5026 Salzburg, Austria
| | - Christoph Steiner
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Katharina Zeman-Kuhnert
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Alexander Gaggl
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
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Ritschl LM, Schwarz M, Klinger F, Wolff KD, Niu M, Weitz J. Extended orbital exenteration, epithetic restoration, and patient supply: A cross-sectional study of a historic cohort. Head Neck 2024; 46:473-484. [PMID: 38095351 DOI: 10.1002/hed.27594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/01/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the clinical course and to redefine an optimized algorithm for OE cases until epithetic restoration. METHODS Indication, 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. RESULTS A 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. CONCLUSIONS We recommend our modified treatment algorithm to further improve and shorten the clinical course.
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Affiliation(s)
- Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Schwarz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Franziska Klinger
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Minli Niu
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Jochen Weitz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, Augsburg, Germany
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Barbera G, Todaro M, Saponaro G, Gasparini G, Moro A. Orbital Exenteration in Recurrence Cancer: 5 Years Experience. J Clin Med 2023; 12:6180. [PMID: 37834824 PMCID: PMC10573591 DOI: 10.3390/jcm12196180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/10/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION The purpose of this study was to assess the overall survival (OS) and disease-free survival (DFS) of patients who underwent orbital exenteration for periorbital, conjunctival, and primary intraorbital carcinomas. Additionally, we assessed the outcomes of anterior retrograde temporalis muscle flap restoration. METHODS For all patients who had orbital exenteration in the previous five years, a non-comparative retrospective assessment of their medical records, histology, and radiographic imaging was carried out. We investigated the relationships between the various qualitative factors using Cramer's V Kaplan-Meier (KM) analysis. For each of the patient's categorical factors that were of relevance, estimates of the survival distribution were displayed, and log-rank tests were used to determine whether the survival distributions were equal. RESULTS This study looks at 19 participants. The sample is made up of 13 men (68%) and 6 women (32%). The degree of relationship (Cramer's V index) between lymph node metastases (N) and the existence of distant metastases (M) is high, at 64%, and is statistically significant because the p-value is 0.0034 < 0.005. Lymph node metastases had a statistically significant impact on overall survival (p = 0.04 < 0.05). Thirteen of the nineteen patients tested had no palsy (68%). There was no one presenting a CSF leak. CONCLUSION Our findings show how crucial it is to identify any lymph node involvement that orbital neoplasms may have. In patients who have received many treatments, sentinel lymph node biopsy (SLNB) may be used to determine the stage and spread of the cancer. To determine whether additional tumor characteristics may be explored, more expertise in the SLNB field for patients with orbital cancer who have received many treatments may be helpful. To prevent additional scarring and to be comparable to previous techniques for facial nerve lesions, the anterior retrograde approach and the transorbital procedure for temporal muscle flap in-setting are both effective methods.
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Affiliation(s)
- Giorgio Barbera
- Maxillo Facial Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS Hospital, 8 Largo Agostino Gemelli, 00168 Rome, Italy; (M.T.); (G.S.); (G.G.); (A.M.)
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Qedair J, Haider AS, Balasubramanian K, Palmisciano P, Hassan T, Shahbandi A, Sabahi M, Kharbat AF, Abou-Al-Shaar H, Yu K, Cohen-Gadol AA, El Ahmadieh TY, Bin-Alamer O. Orbital Exenteration for Craniofacial Lesions: A Systematic Review and Meta-Analysis of Patient Characteristics and Survival Outcomes. Cancers (Basel) 2023; 15:4285. [PMID: 37686561 PMCID: PMC10487227 DOI: 10.3390/cancers15174285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/27/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The outcomes of orbital exenteration (OE) in patients with craniofacial lesions (CFLs) remain unclear. The present review summarizes the available literature on the clinical outcomes of OE, including surgical outcomes and overall survival (OS). METHODS Relevant articles were retrieved from Medline, Scopus, and Cochrane according to PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management, and outcomes. RESULTS A total of 33 articles containing 957 patients who underwent OE for CFLs were included (weighted mean age: 64.3 years [95% CI: 59.9-68.7]; 58.3% were male). The most common lesion was squamous cell carcinoma (31.8%), and the most common symptom was disturbed vision/reduced visual acuity (22.5%). Of the patients, 302 (31.6%) had total OE, 248 (26.0%) had extended OE, and 87 (9.0%) had subtotal OE. Free flaps (33.3%), endosseous implants (22.8%), and split-thickness skin grafts (17.2%) were the most used reconstructive methods. Sino-orbital or sino-nasal fistula (22.6%), flap or graft failure (16.9%), and hyperostosis (13%) were the most reported complications. Regarding tumor recurrences, 38.6% were local, 32.3% were distant, and 6.7% were regional. The perineural invasion rate was 17.4%, while the lymphovascular invasion rate was 5.0%. Over a weighted mean follow-up period of 23.6 months (95% CI: 13.8-33.4), a weighted overall mortality rate of 39% (95% CI: 28-50%) was observed. The 5-year OS rate was 50% (median: 61 months [95% CI: 46-83]). The OS multivariable analysis did not show any significant findings. CONCLUSIONS Although OE is a disfiguring procedure with devastating outcomes, it is a viable option for carefully selected patients with advanced CFLs. A patient-tailored approach based on tumor pathology, extension, and overall patient condition is warranted.
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Affiliation(s)
- Jumanah Qedair
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia;
- King Abdullah International Medical Research Center (KAIMRC), Jeddah 22384, Saudi Arabia
| | - Ali S. Haider
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Paolo Palmisciano
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95819, USA
| | - Taimur Hassan
- Texas A&M School of Medicine, Texas A&M University, Houston, TX 77030, USA
| | - Ataollah Shahbandi
- Tehran School of Medicine, Tehran University of Medical Science, Tehran 1416634793, Iran
| | - Mohammadmahdi Sabahi
- Department of Neurological Surgery, Pauline Braathen Neurological Centre, Cleveland Clinic Florida, Weston, FL 33331, USA
| | | | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15219, USA
| | - Kenny Yu
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Aaron A. Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Othman Bin-Alamer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15219, USA
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Kuehnel S, Grimm A, Bohr C, Hosemann W, Weber R, Ettl T, Kuehnel T. Reconstruction of the Exenterated Orbit with an Island Pericranial Flap: A New Surgical Approach. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5082. [PMID: 37448763 PMCID: PMC10337710 DOI: 10.1097/gox.0000000000005082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/28/2023] [Indexed: 07/15/2023]
Abstract
Reconstruction of the bony socket after orbital exenteration is a matter of much debate. Prompt defect closure with a microvascular flap is desirable but involves a major surgical procedure and hence, places considerable burden on the patient. The new surgical technique presented here permits a technically simpler wound closure with fewer complications after orbital exenteration. Methods Between May 2014 and June 2022 in the ENT department of Regensburg University, nine patients underwent exenteration and reconstruction with a pericranial flap. The flap was raised via a broken line incision in the forehead or endoscopically, incised in a roughly croissant-like shape, then introduced into the orbit through a tunnel in the eyebrow. A retrospective analysis of the patients and considerations about determining the size, shape, and vascular supply of the flap are presented. Results Flap healing was uncomplicated in all cases. Only 6 weeks after surgery, the flap was stable, making it possible to start adjuvant therapy and prosthetic rehabilitation swiftly. The flap is adapted to the near cone-shape of the orbit. The mean (± standard deviation) surface area of the measured orbits is (39.58 ± 3.32) cm2. The territory of the angular artery provides the periosteal flap arterial blood supply. Venous drainage is via venous networks surrounding the artery. Conclusions Use of the pericranial flap makes it possible to close the orbital cavity promptly with minimal donor site defect and a short operating time, thereby minimizing the surgical risk and speeding up physical and psychological recovery.
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Affiliation(s)
- Sophia Kuehnel
- From the Department of Ophthalmology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - András Grimm
- Anatomical Institute, Semmelweis University, Budapest, Hungary
| | - Christopher Bohr
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Werner Hosemann
- ENT Department, Helios Hanseklinikum Stralsund, Stralsund, Germany
| | | | - Tobias Ettl
- Department of Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Kuehnel
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
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Orbital Extenteration Defects: Ablative and Reconstructive Flowchart Proposal. J Craniofac Surg 2022; 34:893-898. [PMID: 36217235 DOI: 10.1097/scs.0000000000009052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Orbital exenteration is a radical and disfiguring operation. It is still under debate the absence of correlation between the term describing the resulting orbital defect and the type of reconstruction. Authors' goal was to propose a consistent and uniform terminology for Orbital Exenteration surgery in anticipation of patients' tailored management. Twenty-five patients who underwent orbital exenteration between 2014 and 2020 were reviewed. A parallel comprehensive literature review was carried on. Five different types of orbital exenteration where outlined. Multiple reconstructive procedures were enclosed. An algorithm for orbital reconstruction was proposed based on anatomic boundaries restoration. Eyelid removal was first considered as an independent reconstructive factor, and both orbital roof and floor were indicated as independent reconstructive goals, which deserve different defect classification. In our opinion, this algorithm could be a useful tool for patient counseling and treatment selection, which might allow a more tailored patient care protocol. LEVEL OF EVIDENCE Level III.
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Popić B, Kopić A, Holik D, Dinjar K, Kopić V, Matijević M, Popić F. Lateral orbital wall reconstruction after basal cell carcinoma penetration—Case report. Front Surg 2022; 9:925824. [PMID: 36132206 PMCID: PMC9483005 DOI: 10.3389/fsurg.2022.925824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Advanced periorbital basal cell carcinomas may necessitate orbital exenteration and consequent vision loss, which significantly reduces patients’ life quality. Orbital reconstruction is a demanding surgical procedure due to the complex orbital anatomy and vital structures located in the orbit. In this report, we presented an 83-year-old patient with advanced basal cell carcinoma that had expanded into the orbit. An orbitotomy was performed to remove the tumor completely while preserving the eye function. Orbital reconstruction was performed by a standard surgical method using a titanium mesh modeled according to a natural phantom skull. This maintained the eye function and achieved satisfactory facial esthetics.
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Affiliation(s)
- Bruno Popić
- Department of Maxillofacial and Oral Surgery, Osijek University Hospital Centre, Osijek, Croatia
| | - Andrijana Kopić
- Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Correspondence: Andrijana Kopić
| | - Dubravka Holik
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Kristijan Dinjar
- Department of Maxillofacial and Oral Surgery, Osijek University Hospital Centre, Osijek, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vlatko Kopić
- Department of Maxillofacial and Oral Surgery, Osijek University Hospital Centre, Osijek, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marko Matijević
- Dental Practice, Community Healthcare Center of Osijek-Baranja County, Osijek, Croatia
| | - Fran Popić
- Dental Practice, Community Healthcare Center of Osijek-Baranja County, Osijek, Croatia
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Akyurek M, Benli C, Esmer S. Our experience with the management of non-melanoma skin cancers with orbital invasion. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01969-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Bottini GB, Hutya V, Kummer D, Steiner C, Zeman-Kuhnert K, Wittig J, Gaggl A. Microvascular reconstruction of the orbit and adjacent regions: A case series. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tsoutsanis PA, Charonis GC. Congenital orbital teratoma: a case report with preservation of the globe and 18 years of follow-up. BMC Ophthalmol 2021; 21:456. [PMID: 34963454 PMCID: PMC8715611 DOI: 10.1186/s12886-021-02229-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Congenital orbital teratomas are extremely rare, usually benign neoplasms, comprised of cells originating from all three germ cell layers. Clinically the tumor appears solid, most of the times is intraconal and presents as a rapidly growing mass leading to a massive unilateral axial proptosis, chemosis, exposure keratopathy, markedly distended eyelids and often, loss of vision. To prevent these complications, tumor excision usually involves enucleation or even orbital exenteration. Case presentation We report a case of a 1-day old infant who presented with dramatic proptosis at birth due to a true congenital orbital teratoma. We describe the clinical findings, the preoperative neuroimaging, the surgical management which included complete tumor resection with preservation of the globe to allow for optimal orbital growth, the histopathological evaluation, and the clinical course during 18 years of follow up. Conclusion Every effort to salvage the globe should be made to achieve the best possible orbito-facial development. Furthermore, the value of prompt surgical management with a less invasive transconjunctival globe sparing procedure can be appreciated in our case.
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Turri-Zanoni M, Arosio AD, Agosti E, Battaglia P, Cherubino M, Balbi S, Margherini S, Locatelli D, Valdatta L, Castelnuovo P. Endoscopic-assisted orbital exenteration: Technical feasibility and surgical results from a single-center consecutive series. J Craniomaxillofac Surg 2021; 50:156-162. [PMID: 34857442 DOI: 10.1016/j.jcms.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/26/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022] Open
Abstract
The purposes of this study were to describe the endoscopic-assisted orbital exenteration surgical techniques, to report preliminary outcomes and to discuss advantages, indications and limitations of this approach. All patients who underwent endoscopic-assisted orbital exenteration at a single tertiary-care center were retrospectively reviewed. A concomitant reconstruction was performed in all cases. The extent of surgical resection was tailored to the size and location of tumor and was classified into four subtypes. A total of 40 patients were included in this series. Orbital exenteration type 1 was performed in 7 cases, type 2 in 11 cases, type 3 in 19 cases, and type 4 in 3 cases. The reconstruction was performed with a pedicled temporal flap in 5 patients and with a free vascularized flap in 34 cases. A radical resection of disease was obtained in 32 cases. After a mean follow-up of 36 months, 14 patients died of disease, one patient died of other causes, 7 are alive with disease, and 18 patients are currently alive without evidence of disease. The preliminary data emerging from this case-series support the feasibility and safety of endoscopic-assisted orbital exenteration.
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Affiliation(s)
- Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Alberto Daniele Arosio
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Edoardo Agosti
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Cherubino
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Sergio Balbi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Stefano Margherini
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Luigi Valdatta
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Social Perception of Reconstruction following Orbital Exenteration. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3883. [PMID: 34712543 PMCID: PMC8547912 DOI: 10.1097/gox.0000000000003883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
Background: Orbital exenteration, the removal of the entire globe, eyelids, and orbital content, is indicated in extensive neoplastic disease involving the orbital region. Although a functional reconstruction of orbital exenteration defects is mandatory, aesthetic concerns need to be considered. Facial disfigurement following reconstructive surgery often leads to great discomfort and social retirement, which can limit social interaction. The aim of this study was to explore how the society perceives the aspect of patients who underwent orbital exenteration and subsequent reconstruction, comparing two different types of reconstruction: standard anterolateral thigh (ALT) or “sandwich” fascial ALT (SALT) free flap. Methods: An online survey was created based on four questions regarding the perception of reconstruction (discomfort at looking at that patient, perception of unhealthiness, hypothesis of social life impairment, etc); five possible answers were provided, ranging from “completely” to “not at all.” The survey was administered to the general population and to medical students. Results: In total, 255 people participated to the survey (130 medical students and 125 people of the general population); a total of 245 surveys were considered eligible (10 were incomplete and then discharged). Statistical significance was found (P < 0.001) regarding the better overall appearance of the SALT group over the ALT one. Conclusions: After analysis, the surgical outcome after SALT reconstruction has been found to be less disruptive in both groups, due to a reduced scar burden and a more pleasant orbital pocket. Our results encourage more research in the field of postexenteration reconstruction to achieve more aesthetic and social acceptability.
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14
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Osseointegrated Implants for Orbito-Facial Prostheses: Common Complications and Solutions. J Craniofac Surg 2021; 32:1770-1774. [PMID: 33741879 DOI: 10.1097/scs.0000000000007360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate anatomical and functional results of osseointegration with magnetic coupling for oculofacial prosthetic rehabilitation after exenteration. METHODS This retrospective study included 11 consecutive patients who received orbital reconstruction and oculofacial prosthetic rehabilitation between September 2015 and October 2019. Patient demographics, surgical indications, previous treatment procedures, histopathologic features, and reconstructive procedures were recorded. RESULTS The mean age was 37.81 ± 23 years (range 5-78 years). The mean follow-up was 23.81 ± 12 months (range 10-48 months). The principal diagnoses were squamous cell carcinoma of the eyelids (n = 2/11), mucoepidermoid carcinoma of the maxillary sinus (n = 2/11), rhabdomyosarcoma (n = 1/11), mucormycosis (n = 1/11), neurofibromatosis (n = 1/11), basosquamous carcinoma (n = 1/11), malign melanoma (n = 1/11), primitive neuroectodermal tumor (n = 1/11), and retinoblastoma (n = 1/11). Six of the patients were repaired by primary closure. Procedures performed to reconstruct the orbital cavity included split-thickness skin graft (n = 2/11), temporalis muscle flap (n = 2/11), and frontalis muscle flap (n = 1/11). Nine of the 11 patients who received orbital implants were successfully rehabilitated by epithesis. Postoperative complications included implant loss (n = 4/11), periprosthetic local infection (n = 3/11), and soft tissue overgrowth around the orbital prosthesis (n = 2/11). All patients had Straumann bone level implant (Basel, Switzerland) osseointegrated titanium implants (3.5 mm) placed in a 2-stage procedure over a span of 3 to 4 months with subsequent successful prosthesis fitting. CONCLUSION The reconstructive methods following orbital exenteration, should be customized according to the patients' characteristics such as extension of the orbital defect, bone quality, and expectations to achieve satisfactory results.
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15
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Rauchenwald T, Dejaco D, Henninger B, Morandi EM, Pülzl P, Pierer G, Riechelmann H, Wolfram D. Simple, but effective: Nasal splinting for airway securement in free flap reconstruction following orbital exenteration. Head Neck 2021; 43:3238-3244. [PMID: 34268827 PMCID: PMC8457228 DOI: 10.1002/hed.26815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/17/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022] Open
Abstract
Orbital exenteration is a disfiguring procedure that often results in free tissue transfer for reconstructive purposes. The reconstructive focus is the obliteration of dead space while sparing the nasal airway, particularly if the medial orbital wall was resected. Prolapse of transferred tissue into the nasal airway may cause breathing difficulties drastically compromising quality of life. The objective of this study was to demonstrate the effectiveness and feasibility of temporary nasal septum splints as mechanical support for transferred tissue, to prevent airway obstruction. This novel application technique was employed in three patients between 2017 and 2018. No flap loss or sino‐orbital fistulas were observed. On postoperative MRI and endoscopy, a patent nasal airway was observed at all times. Temporary nasal splinting in combination with free tissue transfer proved to be a simple, but effective reconstructive option for securing the nasal airway following orbital exenteration with resection of the medial orbital wall.
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Affiliation(s)
- Tina Rauchenwald
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Petra Pülzl
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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16
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Reconstruction of Orbital Exenteration Defect With Cheek or Combined Cheek and Forehead Advancement Flaps. Ophthalmic Plast Reconstr Surg 2021; 37:346-351. [PMID: 33060513 DOI: 10.1097/iop.0000000000001869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the outcomes of orbital exenteration defect reconstruction using cheek or combined cheek-forehead advancement flap. METHODS Charts of 14 patients who underwent reconstruction of the exenterated orbit with cheek advancement flap were reviewed. In surgery, a cheek flap elevated via a nasofacial sulcus incision, and preperiosteal dissection was advanced over the defect. The upper orbital defect, if necessary, was covered with a forehead flap, which was dissected through an incision in the midline or temporal forehead and advanced inferiorly. RESULTS In all patients (7 women, 7 men; mean age, 65 years), total (n = 7) or extended (n = 7) exenteration was performed for a malignant tumor. In 12 patients (86%), the defect was primarily closed with cheek flap alone (n = 6) or cheek plus forehead (n = 6) advancement flaps. Eight patients received radiotherapy before and after surgery. Four patients (29%) had a total of 6 postoperative complications (skin graft infection, orbital cavitary abscess, osteomyelitis, chronic skin ulcer, and 2 sino-orbital fistulae). The mean follow-up duration was 43 months (range, 11-79 months). CONCLUSIONS Cheek advancement flap can be used alone or together with a forehead advancement flap to cover the orbital defects after total or extended exenteration. This repair may be resistant to radiotherapy-related complications in some cases.
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17
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Law JJ, Baker LX, Chen Q, Mawn LA, Barahimi B, Kupcha AC, Alford MA, Sobel RK. Porcine Urinary Bladder Extracellular Matrix for Treatment of Periocular Skin Defects. Ophthalmic Plast Reconstr Surg 2021; 37:S6-S10. [PMID: 32618823 DOI: 10.1097/iop.0000000000001738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the experience of 4 oculoplastic surgeons with porcine bladder matrix for periocular anterior lamella and donor site skin defects either as stand-alone treatment or in conjunction with other reconstructive procedures. The authors hypothesized that defect size and location influence the requirement for additional matrix treatments or ancillary procedures. METHODS Following the Institutional Review Board approval, the authors conducted a retrospective review of 17 patients treated with porcine bladder matrix at 2 oculoplastic practices between 2016 and 2018. Powdered matrix was applied to the skin defect and overlaid with a matrix sheet. Subsequent rounds of matrix treatment or other reconstructive procedures were performed as necessary. Defect size and location were correlated to the number of ancillary matrix treatments or surgical procedures via univariate analysis. RESULTS Twenty-five sites (21 primary and 4 donor) in 17 individuals (8-95 years, M = 58.8 years, 10 males) were treated with porcine bladder matrix. All wounds healed successfully. Additional matrix treatments were administered at 5 sites. Ancillary procedures were performed for 7 sites. Upper lid involvement and larger defect size tended to require additional ancillary procedures (p = 0.006), while lower eyelid and other periocular defects required fewer procedures (p < 0.001). CONCLUSION Porcine bladder matrices are useful adjuncts to healing periocular anterior lamella defects in various settings. Such repairs are useful in nonsurgical candidates, but must take into account varying levels of complexity based on lesion location. Smaller defects are more conducive to application of matrices as stand-alone treatment, while larger or upper eyelid defects often require additional procedures.
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Affiliation(s)
- James J Law
- Department of Ophthalmology and Visual Sciences
- Vanderbilt University School of Medicine, Nashville
| | | | - Qingxia Chen
- Department of Ophthalmology and Visual Sciences
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Louise A Mawn
- Department of Ophthalmology and Visual Sciences
- Vanderbilt University School of Medicine, Nashville
| | - Behin Barahimi
- Department of Ophthalmology and Visual Sciences
- Vanderbilt University School of Medicine, Nashville
| | | | - Mark A Alford
- North Texas Ophthalmic Plastic Surgery, Fort Worth, Texas, U.S.A
| | - Rachel K Sobel
- Department of Ophthalmology and Visual Sciences
- Vanderbilt University School of Medicine, Nashville
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18
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Zloto O, Minard‐Colin V, Boutroux H, Brisse HJ, Levy C, Kolb F, Bolle S, Carton M, Helfre S, Orbach D. Second-line therapy in young patients with relapsed or refractory orbital rhabdomyosarcoma. Acta Ophthalmol 2021; 99:334-341. [PMID: 32833335 DOI: 10.1111/aos.14596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Localized orbital rhabdomyosarcoma (oRMS) has an overall favourable prognosis with more than 90% of survival. Little is known about the best strategy in recurrent/refractory (R/R) cases. The purpose is to examine the characteristics of patients with R/R-oRMS, focusing on local therapy. METHODS This is bicentric retrospective study. Analysis is of young patients (<30 years) with R/R-oRMS who were treated from 1989 to 2018 at the Institut Curie and Gustave Roussy Cancer Campus, France. RESULTS Twenty-seven out of 162 patients (17%) with oRMS presented with R/R disease. 6 of these patients had alveolar RMS (22%), 3 of whom had initial parameningeal extension (11%). During first-line treatment, 18 patients (67%) had orbital radiotherapy. Median age at R/R was 10 years (ranges: 4-28) after a delay of 19 months from diagnosis (ranges: 3-40). Tumoral events were local relapses (22 cases), local progression (3 cases) or regional relapses (2 cases). Second-line treatments included chemotherapy (27 cases), radiotherapy (16 cases), surgery (exenteration; 8 cases) and metastasis/ nodal removal (3 cases). After a median follow-up of 99 months (range: 10-306), 4 patients died and 23 are in complete remission (CR) without treatment. One patient had subsequent relapse treated with exenteration and brachytherapy until a new tumour remission. Five-year event-free and overall survivals after first tumour event are, respectively, 84.4% (95% confidence interval: 71.5%-98.8%) and 85.8% (95% confidence interval: 72.1%-100.0%) CONCLUSION: R/R-oRMS is a rare situation. Second-line therapy is efficient in this location, sometime at the cost of lifesaving mutilating surgery. Second-line local therapy needs therefore to consider local radiotherapy if possible or complete wide surgery.
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Affiliation(s)
- Ofira Zloto
- Goldschleger Eye Institute Sheba Medical Center Affiliated with The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer) Institut Curie PSL University Paris France
| | - Veronique Minard‐Colin
- Pediatric Adolescent Young Adult Department Institut de Cancérologie Gustave Roussy Cancer Campus (GRCC) Villejuif France
| | - Helene Boutroux
- Department of Pediatric Hematology and Oncology Trousseau Hospital (AP‐HP) Paris France
| | | | | | - Frederic Kolb
- Plastic Surgery Department Institut de Cancérologie Gustave Roussy Cancer Campus (GRCC) Villejuif France
| | - Stephanie Bolle
- Radiation Oncology Department Institut de Cancérologie Gustave Roussy Cancer Campus (GRCC) Villejuif France
| | - Matthieu Carton
- Department of Biostatistics Institut Curie PSL University Paris France
| | | | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer) Institut Curie PSL University Paris France
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Miechowicz S, Wojnarowska W, Majkut S, Trybulec J, Pijanka D, Piecuch T, Sochacki M, Kudasik T. Method of designing and manufacturing craniofacial soft tissue prostheses using Additive Manufacturing: A case study. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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20
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Supit T, Pujisriyani, Subiyakto, Nugroho T, Fitrikasari A, Najatullah. Giant conjunctival melanoma in a paranoid schizophrenic man: A case report. Ann Med Surg (Lond) 2021; 62:391-394. [PMID: 33552501 PMCID: PMC7851416 DOI: 10.1016/j.amsu.2021.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION and importance: Conjunctival melanoma (CM) is a rare and potentially lethal ocular tumor. As with any oncologic disease, early diagnosis and appropriate treatment of CM is paramount to limit morbidity and increase life expectancy. However, patients with severe mental disability with social isolation are usually presented in late-stage disease. CASE PRESENTATION This report presents a case of a 55-year-old man with paranoid schizophrenic man with an extraordinarily large CM due to neglect. The patient suffered from complete left eye blindness with no clinical and radiological evidence of metastasis. CLINICAL DICUSSION Clinicians must bear in mind the limited patient compliance and family support of mentally-ill patients that restricts treatment modalities that would have otherwise been applicable for cooperative patients. The importance multidisciplinary approach, choosing the simpler but effective surgical technique should be prioritized. INTERVENTION AND OUTCOME Left exenteration and tumor wide excision was performed. The left orbital defect was reconstructed using forehead flap and split-thickness skin graft (STSG). The uncooperative nature of the patient posed early post-operative challenges that necessitates subsequent operation to drain seroma. The patient was discharged 16-days after operation with acceptable cosmetic and clinical results. However, the patient failed to return to the clinic for longer post-operative evaluation. CONCLUSION A multidisciplinary approach is mandatory to treat complex cases such as this report. Surgeons are advised to adopt simpler surgical approach that will require minimal self-care and should encourage family members to continuously support the patient.
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Affiliation(s)
- Tommy Supit
- Department of General Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
| | - Pujisriyani
- Department of Plastic Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
| | - Subiyakto
- Department of Oncologic Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
| | - Trilaksana Nugroho
- Department of Ophthalmology, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
| | - Alifiati Fitrikasari
- Department of Psychiatry, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
| | - Najatullah
- Department of Plastic Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
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21
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Baum SH, Mohr C. Reconstruction of Orbital Exenteration Defects with Cheek Rotation Flaps: Indications, Technique, Complications, Rehabilitation, and Survival. Facial Plast Surg 2021; 37:288-295. [PMID: 33445195 DOI: 10.1055/s-0040-1715618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The objective of this study was to examine the role of cheek rotation flaps in the reconstruction of orbital defects after exenteration. From January 2000 to August 2018, patients undergoing orbital exenteration and reconstruction with cheek rotation flaps were enrolled in this retrospective study. All patients were evaluated for wound complications, orbital rehabilitation, tumor relapse, and survival. Thirty patients completed the study. Fourteen complications allocated to 11 patients were assessed. The most common complications were seroma (13%), temporary facial nerve weakness (13%), and partial necrosis of the flap (10%). A major complication occurred in a total of two patients (7%), so that surgical correction was necessary. Eleven patients had a relapse; 15 patients died as part of the follow-up. Fifteen patients were treated with facial prostheses. The overall survival rate was 61% after 1 year and 42% after 5 years. Follow-up periods ranged from 6 to 95 months. Cheek rotation flap reconstruction after exenteration is a reliable method with a low rate of major complications. It is indicated when an approach to the parotid gland or the neck region is necessary because of suspected lymph node metastasis and in elderly patients because of their skin's laxity. It can be performed as primary or secondary reconstruction. Good esthetic results can be achieved, especially after endosseous implantation.
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Affiliation(s)
- Sven Holger Baum
- Department of Oral and Maxillofacial Surgery, University of Duisburg-Essen, Kliniken-Essen-Mitte, Essen, Germany
| | - Christopher Mohr
- Department of Oral and Maxillofacial Surgery, University of Duisburg-Essen, Kliniken-Essen-Mitte, Essen, Germany
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22
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Battista RA, Giordano L, Giordano Resti A, Bordato A, Trimarchi M, Familiari M, Ferraro M, Bandello FM, Bussi M. Combination of Mustardè cheek advancement flap and paramedian forehead flap as a reconstructive option in orbital exenteration. Eur J Ophthalmol 2020; 31:1463-1468. [PMID: 33238764 DOI: 10.1177/1120672120976550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To describe a combinatory technique made of Mustardè cheek advancement flap and paramedian forehead flap as a reconstructive option after orbital exenteration. METHODS We retrospectively reviewed all patients who underwent orbital exenteration and subsequent reconstruction with this technique at our Head and Neck Department, Divisions of Ophthalmology and Otolaryngology, at San Raffaele Hospital, Milan, Italy. RESULTS Three patients were treated with the aforementioned technique, following orbital exenteration due to malignancies. All of them were affected by recurrent diseases arising from the ocular components or periorbital structures: one basal cell carcinoma and two squamous cell carcinomas. Excellent result was achieved considering skin texture and colour match, aesthetic results and intra and post-operative complications (only minor, surgically controlled haemorrhage and minimal dehiscence subsequent to defective healing occurred). CONCLUSION The proposed technique can be considered by the head and neck reconstructive surgeon as a good option in extended orbital exenteration.
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Affiliation(s)
- Rosa Alessia Battista
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Otolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leone Giordano
- Department of Otolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Alessandro Bordato
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Otolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Otolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Familiari
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Otolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Milena Ferraro
- Department of Otolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Maria Bandello
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Otolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Otolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
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23
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Fleming JC, Morley I, Malik M, Orfaniotis G, Daniel C, Townley WA, Jeannon JP. Orbital exenteration and reconstruction in a tertiary UK institution: a 5-year experience. Orbit 2020; 40:306-315. [PMID: 32543976 DOI: 10.1080/01676830.2020.1775262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Orbital exenteration is a radical oncological surgery that is usually indicated for advanced primary orbital tumors or invasion from local malignancy. We report a 5-year series from a tertiary head and neck center with particular focus on our ablative and reconstructive approach. METHODS We performed a clinicopathological review of patients referred to Guy's and St Thomas' NHS Foundation Trust Head and Neck multidisciplinary team for management input of an orbital malignancy during the period of 2013 to 2018. Cases involving local invasion from sinonasal malignancy were excluded. The reconstructive approach, perioperative complications, disease-free and overall survival were analyzed. RESULTS 27 patients were identified and of those treated surgically, a radical extended orbital exenteration was required in almost half (44.4%), with squamous cell carcinoma being the most common pathology (55.6%). A concurrent neck dissection and parotidectomy were commonly performed with confirmed or suspected regional disease, or in the presence of high-risk pathological features. This approach resulted in favourable 2-year overall survival in these advanced stage cases of 84.6% and disease-free survival of 73.2%, with 92% achieving a negative surgical margin. The majority of treated patients required a free flap reconstruction, especially when an extended exenteration defect or adjuvant treatment was anticipated. The anterolateral thigh flap was the most commonly used donor site, and we present our algorithm for reconstruction of these defects. CONCLUSIONS A multidisciplinary approach to advanced orbital malignancy with a comprehensive approach to surgical resection and reconstruction results in favorable oncological outcomes and addresses functional and cosmetic patient rehabilitation.
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Affiliation(s)
- J C Fleming
- Guy's & St Thomas' NHS Foundation Trust, Department of ENT, Great Maze Pond, London, UK
| | - I Morley
- Guy's & St Thomas' NHS Foundation Trust, Department of ENT, Great Maze Pond, London, UK
| | - M Malik
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - G Orfaniotis
- Guy's & St Thomas' NHS Foundation Trust, Department of ENT, Great Maze Pond, London, UK
| | - C Daniel
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - W A Townley
- Guy's & St Thomas' NHS Foundation Trust, Department of ENT, Great Maze Pond, London, UK
| | - J P Jeannon
- Guy's & St Thomas' NHS Foundation Trust, Department of ENT, Great Maze Pond, London, UK
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Orbital exenteration: Symptoms, indications, tumour localizations, pathologies, reconstruction, complications and survival. J Craniomaxillofac Surg 2020; 49:659-669. [PMID: 33992516 DOI: 10.1016/j.jcms.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/18/2020] [Accepted: 05/27/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aims to evaluate malignant and benign diseases that lead to orbital exenteration. PATIENTS From December 1999 to September 2017, patients undergoing orbital exenteration were included in this retrospective study. All of them were evaluated on clinical symptoms, indications, tumour localizations, pathologies, reconstruction techniques, complications, recurrences, and survival. RESULTS Of the 205 patients enrolled in this study, 94 had a carcinoma, 73 melanoma, 9 a sarcoma, 14 some other malignant disease, and 15 a benign medical condition. Sixteen patients underwent reconstruction using a local eyelid skin flap (7.8%), 6 with a split-thickness graft (2.9%), 144 with a local flap (70.2%), and 25 with a microvascular graft (12.2%), whereas 14 patients did not undergo reconstruction (6.8%). The most common complications were wound dehiscences (25 cases), pain (17 cases), and partial flap necroses (13 cases). Moreover, 62% of the patients were treated with different facial prostheses or artificial eyes. Given these results, it appears that lymph nodes and distant metastases, as well as lymphatic invasion into vessels, perineural invasion, and non-cleared resection margins, seem to affect overall survival after orbital exenteration. CONCLUSION Different reconstruction techniques can be used to provide the patient with maximum functionality and aesthetics after orbital exenteration. Individual concepts should be discussed at the beginning of the treatment. Using primary reconstruction and providing osseointegrated implant-retained prostheses remain the gold standard.
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Weitz J, Spaas C, Wolff KD, Meyer B, Shiban E, Ritschl LM. A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach. Front Oncol 2019; 9:1130. [PMID: 31709189 PMCID: PMC6823187 DOI: 10.3389/fonc.2019.01130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
Reconstructions of complex scalp after ablative resection or by post-traumatic tissue loss, can present difficulties regarding recipient vessel selection, functional, and aesthetic outcome. The harvesting method for many microvascular free flaps requires a need for changing patients position during surgery and makes a simultaneous interdisciplinary two-team approach complicated, which is a major disadvantage regarding safety and operation time. The ideal flap for scalp reconstruction has yet to be described, although the microvascular latissimus dorsi flap is frequently referred to as the first choice in this context, especially after resection of large defects. The purpose of this study is to compare two different microvascular free flaps for a simultaneous scalp reconstruction in an interdisciplinary two-team approach applying a standardized algorithm. All consecutively operated complex scalp defects after ablative surgery from April 2017 until August 2018 were included in this retrospective study. The indications were divided into neoplasm or wound healing disorder. Two microvascular flaps (latissimus dorsi or parascapular flap) were used to cover the soft tissue component of the resulting defects. Seventeen patients met the inclusion criterion and were treated in an interdisciplinary two-team approach. Skull reconstruction with a CAD/CAM implant was performed in 10 cases of which four were in a secondary stage. Nine patients received a parascapular flap and eight patients were treated with latissimus dorsi flap with split thickness skin graft. Anastomosis was performed with no exception to the temporal vessels. One parascapular flap had venous insufficiency after 1 week followed by flap loss. One latissimus dorsi flap had necrosis of the serratus part of the flap. All other flaps healed uneventful and could be further treated with adjuvant therapy or CAD/CAM calvarial implants. Regarding overall complications, flap related complications, flap loss, and inpatient stay no statistical differences were seen between the diagnosis or type of reconstruction. The parascapular flap seems to be a good alternative for reconstruction of complex tumor defects of the scalp besides the latissimus dorsi flap. Stable long-term results and little donor site morbidity are enabled with good aesthetic outcomes and shorter operation time in an interdisciplinary two-team approach.
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Affiliation(s)
- Jochen Weitz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Christophe Spaas
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Ehab Shiban
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,Neurosurgery Department, University Hospital of Augsburg, Augsburg, Germany
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
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Legocki AT, Miles BA. Considerations in Orbital Reconstruction for the Oncologic Surgeon: Critical versus Optimal Objectives. Indian J Plast Surg 2019; 52:231-237. [PMID: 31602141 PMCID: PMC6785328 DOI: 10.1055/s-0039-1696624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Orbital reconstruction following oncologic midface resection is uniquely challenging, and makes critical contributions to patient aesthetics, function, and identity. Approach is largely dependent on surgeon and patient preferences, and there exists no consensus on defect characterization. Objective The goal of the study is to provide a mental framework for the reconstructive oncologic surgeon to use as a foundation during his or her approach to the orbit. Design The design of the study is based on the review of current literature and expert opinion. Conclusions Critical versus optimal objectives must be set in orbital reconstruction, and a systematic approach should be followed. We approach orbital reconstruction by first deciding whether globe-sparing surgery is possible, or if orbital exenteration will be necessary. We then set critical and optimal objectives for our chosen pathway. Critical goals in globe-sparing reconstruction include maintaining orbital volume and preserving visual function, and an optimal goal includes preservation of the nasolacrimal system. Critical goals in orbital exenteration include obliterating the defect, sealing the skull base and nasal cavities, and allowing eye protection to be worn over the contralateral eye postoperatively. Optimal goals in exenteration include preparation for prosthetics, volume and bony replacement, eyelid-sparing technique, and consideration of postoperative radiation.
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Affiliation(s)
- Alex T Legocki
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, United States
| | - Brett A Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, United States
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Novel Use of Porcine Urinary Bladder Matrix in the Exenterated Socket. Ophthalmic Plast Reconstr Surg 2019; 35:e122-e124. [DOI: 10.1097/iop.0000000000001453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Jategaonkar AA, Vernon D, Byrne PJ. Regional Reconstruction of Orbital Exenteration Defects. Semin Plast Surg 2019; 33:120-124. [PMID: 31037049 DOI: 10.1055/s-0039-1685475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aggressive disease such as invasive fungal infections or malignancies may necessitate orbital exenteration. The defects of orbital exenteration are often complex involving adjacent structures. Rehabilitation of the orbital exenteration defect poses unique challenges to the reconstructive surgeon. Various options have been described ranging from secondary intention to microvascular free tissue reconstruction. Here the authors review local/regional options for reconstruction of orbital exenteration defects.
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Affiliation(s)
- Ameya A Jategaonkar
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dominic Vernon
- Division of Facial Plastics and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Maryland
| | - Patrick J Byrne
- Division of Facial Plastics and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Maryland
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Sokoya M, Cohn JE, Kohlert S, Lee T, Kadakia S, Ducic Y. Considerations in Orbital Exenteration. Semin Plast Surg 2019; 33:103-105. [PMID: 31037046 DOI: 10.1055/s-0039-1685209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Orbital exenteration (OE) is a radical operation associated with significant psychosocial disability and functional impairment. Indications for OE include primary tumors of the eye, oral cavity, paranasal sinuses, skin, and brain. Careful consideration regarding the likelihood of local control and cure is needed before proceeding with this operation. Multidisciplinary work-up should be performed before proceeding with surgery. The method of reconstruction after OE should be tailored to the defect and the postoperative needs of the patient. Appropriate follow-up and rehabilitation should be arranged for the patient.
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Affiliation(s)
| | - Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Scott Kohlert
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Thomas Lee
- Department of Otolaryngology Head/Neck Surgery, Virginia Commonwealth University School of Medicine, Virginia
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Wright State University, Dayton, Ohio
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Badhey A, Haidar Y, Genden E. Soft Tissue Microvascular Reconstruction of Orbital Exenteration Defects. Semin Plast Surg 2019; 33:125-131. [PMID: 31037050 DOI: 10.1055/s-0039-1685480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The main goal of head and neck reconstruction is the restoration of form and function. Oncologic surgery makes this process more complex, as the preplanned defect can be very different from its intraoperative counterpart. This emphasizes the role of preoperative planning and a diverse reconstructive "tool box" that can accommodate a variety of complicated defects. The other reconstructive goals are determined by the patient with the aid of an interdisciplinary team. While multiple local and regional reconstructive options are available, free tissue transfer provides a versatile and reliable option for reconstruction-especially for complex orbital defects. Here the authors discuss free soft tissue transfer options for orbital exenteration. This review will catalog the advantages and disadvantages of the radial forearm, rectus abdominis, latissimus, and anterolateral thigh.
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Affiliation(s)
- Arvind Badhey
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yarah Haidar
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
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Vincent A, Kohlert S, Kadakia S, Sawhney R, Ducic Y. Prosthetic Reconstruction of Orbital Defects. Semin Plast Surg 2019; 33:132-137. [PMID: 31037051 DOI: 10.1055/s-0039-1685479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Orbital and craniomaxillofacial defects, in general, are best approached preoperatively by a multidisciplinary team with a clear reconstructive plan in place. Orbital defects result from a myriad of underlying diseases and injuries, and reconstruction after orbital evisceration, enucleation, or exenteration can pose a challenge to the reconstructive team. Reconstruction of orbital injuries with orbital implants and prostheses can lead to acceptable aesthetic outcomes, and the reconstructive surgeon should be familiar with current orbital implants and prostheses. Herein, the authors review terminology and classifications of orbital defects, different types of orbital implants, advantages and disadvantages of different orbital implant reconstructive options, types of orbital prostheses, and pros and cons of different prosthetic options.
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Affiliation(s)
- Aurora Vincent
- Otolaryngology, Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Scott Kohlert
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Canada
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Wright State University, Dayton, Ohio
| | - Raja Sawhney
- Facial Plastics, University of Gainesville, Florida
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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