1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
Gąsiorowski K, Gontarz M, Marecik T, Szczurowski P, Bargiel J, Zapała J, Wyszyńska-Pawelec G. Risk Factors for Orbital Invasion in Malignant Eyelid Tumors, Is Orbital Exenteration Still Necessary? J Clin Med 2024; 13:726. [PMID: 38337420 PMCID: PMC10856173 DOI: 10.3390/jcm13030726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/13/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Basal cell carcinoma is the most common malignant skin tumor of the eyelids in Caucasians, followed by squamous cell carcinoma and sebaceous gland carcinoma. The primary treatment for these tumors is radical excision. In cases where malignant eyelid tumors are advanced and have invaded the orbit, orbital exenteration is necessary. In this retrospective study, we aimed to determine the correlation between the risk of orbital infiltration and various factors like tumor location, size, histological type, and patient age. This study revealed that tumors in multiple regions increased the risk of orbital infiltration by 3.75 times. Tumors with a diameter of 21-30 mm raised the likelihood of requiring exenteration by 15.5 times compared to smaller tumors (up to 10 mm). Age was also associated with the likelihood of orbital invasion in periocular tumors. Interestingly, no correlation was found between the histological type of the tumor and the risk of orbital infiltration. Notably, the conjunctiva of the eyeball was the most commonly infiltrated orbital structure, followed by the orbital fat. Timely treatment and well-planned procedures are crucial for patients with malignant periocular skin tumors to avoid multiple reoperations and the potential need for orbital exenteration.
Collapse
Affiliation(s)
- Krzysztof Gąsiorowski
- Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland; (M.G.); (T.M.); (P.S.); (J.B.); (J.Z.); (G.W.-P.)
| | | | | | | | | | | | | |
Collapse
|
3
|
Singh P, Bajaj MS, Gupta N, Agrawal S. A massive liposarcoma of the orbit. Orbit 2023; 42:569-570. [PMID: 34470545 DOI: 10.1080/01676830.2021.1966814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Pallavi Singh
- DR. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | - Nikita Gupta
- DR. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Sahil Agrawal
- DR. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
5
|
Tan JA, Khoo ET, Al-Chalabi MMM, Mohd Zainal H, Wan Sulaiman WA. Orbital Exenteration and Reconstruction Using a Free Radial Forearm Flap in Conjunctival Melanoma: Old but Gold. Cureus 2023; 15:e42572. [PMID: 37637587 PMCID: PMC10460132 DOI: 10.7759/cureus.42572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Conjunctival melanoma is a rare and potentially deadly tumor. Therefore, adequate oncological resection is essential, commonly leading to total orbital exenteration, which causes patients' extensive functional and cosmetic impairment. As a result, it is essential to reconstruct the orbital region post-exenteration to obliterate the cavity, provide adequate and pliable cutaneous covering, and restore a stable vascularized tissue that can withstand adjuvant radiotherapy. In recent years, the techniques used for orbital reconstruction have included the transorbital temporoparietal fascial flap, the anterolateral thigh flap, and local flaps, such as the paramedian forehead flap. A free radial forearm flap is currently not commonly used for orbital reconstruction due to potential donor site morbidity and cosmetic issues. In our case, we report a free radial forearm fasciocutaneous flap that has been utilized with promising surgical outcomes to reconstruct the orbital region following orbital exenteration.
Collapse
Affiliation(s)
- Ju Ann Tan
- Reconstructive Sciences Unit, Universiti Sains Malaysia (USM), Kota Bharu, MYS
| | - Ee Theng Khoo
- Reconstructive Sciences Unit, Universiti Sains Malaysia (USM), Kota Bharu, MYS
| | | | - Hamidah Mohd Zainal
- Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, MYS
| | | |
Collapse
|
6
|
Rathee M, Chahal S, Alam M, Singh S, Divakar S. Surgical Rehabilitation of a Continuous Orbital and Maxillary Defect from Rhino-Orbital Mucormycosis Utilising Digital Technology - A Case Report. Ann Maxillofac Surg 2023; 13:224-227. [PMID: 38405554 PMCID: PMC10883209 DOI: 10.4103/ams.ams_54_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/13/2023] [Accepted: 09/02/2023] [Indexed: 02/27/2024] Open
Abstract
Rationale COVID-19 has led to a resurgence in cases of mucormycosis, especially the rhino-orbital form affecting the oral cavity, nasal, orbital and cerebral regions. Patient Concerns The surgical treatment in this patient led to the exenteration of orbital contents and segmental maxillectomy of the affected side leading to facial disfigurement and inability to masticate. Diagnosis A combined mucormycosis-associated oro-orbital defect was present leading to a communication between oral and orbital cavities. Treatment Rehabilitation utilising digital technology for removable prosthesis was planned for the combined orbital and oral defect. Outcomes The independent intraoral and orbital prosthesis reduced the mobility of the orbital prosthesis while performing functional movements. The advancements in digital technology led to the convenient and resilient fabrication of prostheses for large facial defects. Take-away Lessons The prosthetic rehabilitation of a continuous orbital and oral defect with a hybrid of both digital and conventional means provided an aesthetic, feasible and financially sound solution to the patient.
Collapse
Affiliation(s)
- Manu Rathee
- Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Sujata Chahal
- Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Maqbul Alam
- Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Sandeep Singh
- Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - S. Divakar
- Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| |
Collapse
|
7
|
Patel VB, Patel A, Mishra G, Shah N, Shinde MK, Musa RK. Imaging spectrum, associations and outcomes in acute invasive fungal rhino-ocular-cerebral sinusitis in patients with COVID-19 pneumonia. J Family Med Prim Care 2023; 12:1055-1062. [PMID: 37636178 PMCID: PMC10451586 DOI: 10.4103/jfmpc.jfmpc_1189_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 08/29/2023] Open
Abstract
Background Coronavirus Disease 2019 (COVID-19) has been speculated to enhance mucormycosis infection due to its immune-altering pathophysiology. Early identification of high-morbidity conditions is crucial for optimal treatment and improved outcomes. Methods A retrospective study was conducted on 63 patients with clinical and microbiological evidence of rhino-ocular-cerebral mucormycosis, who had a history of COVID-19 infection. The clinical, demographic, and imaging data were retrieved and analyzed. Descriptive statistics (mean [SD] and frequency [%]) were used to describe important characteristics across audit cycles. Results Out of 63 patients, 54 (85.71%) patients had associated comorbidities, with diabetes mellitus being common comorbidity and all patients had received injectable and/or oral corticosteroids. Imaging showed nasal and paranasal sinus, perisinus, maxillary alveolar arch, and hard palate involvement in 62 (98.41%), 33 (52.38%), 5 (7.94%) and 5 (7.94%) patients, respectively. Orbital involvement was seen in 24 (38.10%) patients. Skull base involvement was seen in 11 (17.46%) patients, and intracranial extension of disease was present in 11 (17.46%) patients. A total of 16 patients were on mechanical ventilation, of whom 3 succumbed. The mean (standard deviation [SD]) intensive care unit (ICU) stay was 13.2 days (6.8) for 5 patients who succumbed and 6.4 days (4.6) for 30 patients who survived (P value = 0.008). Conclusion Cross-sectional imaging not only provides the extent of disease spread but also plays a vital role in providing a surgical roadmap to treating surgeons and in predicting prognosis in patients with invasive fungal infections.
Collapse
Affiliation(s)
- Viral B. Patel
- Department of Radio Diagnosis, Pramukh Swami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Aashvi Patel
- Department of Otolaryngology, Medical Officer, IRIS Hospital, Anand Gujarat, India
| | - Girish Mishra
- Department of Otolaryngology, Pramukh Swami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Nilay Shah
- ENT and Head – Neck Surgeon, IRIS Hospital, Anand, Gujarat, India
| | - Mayur K. Shinde
- Department of Biostatistics, Pramukh Swami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Raish K. Musa
- Department of Radio Diagnosis, Pramukh Swami Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| |
Collapse
|
8
|
Lalmand M, Gilis S, Raptos A, Simon A, Van Brussel S, Sasserath C. Ten years' blindness of the right eye: A rare presentation of an orbital melanoma. SAGE Open Med Case Rep 2023; 11:2050313X231173786. [PMID: 37284226 PMCID: PMC10240850 DOI: 10.1177/2050313x231173786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 04/18/2023] [Indexed: 06/08/2023] Open
Abstract
Benign and malignant orbital tumours develop from the orbit or invade it from the surrounding tissues. Ocular melanoma is a rare but potentially devastating malignancy arising from the melanocytes of the uveal tract, conjunctiva, or orbit. The poor overall survival depends mainly on its high metastatic rate. Signs and symptoms are variables mainly depending on the size of the tumour. Its treatment consists generally of surgery, radiotherapy or both. We report a case of a patient suffering from unilateral blindness for the last 10 years with a recent swelling of the orbit. The pathological analysis described a uveal melanoma. The patient benefitted from a total orbital exenteration with reconstruction using a temporal flap. Thereafter, the patient received adjuvant radiotherapy and immunotherapy. The patient was in complete remission. No recurrence was highlighted after 2 years of follow-up.
Collapse
Affiliation(s)
- Martin Lalmand
- Department of Oral and Maxillofacial Surgery, CHwapi, Tournai, Belgium
| | - Sarah Gilis
- Department of Oral and Maxillofacial Surgery, CHwapi, Tournai, Belgium
- Department of Oral and Maxillofacial Surgery, EpiCURA, Baudour, Belgium
| | | | | | | | | |
Collapse
|
9
|
Kumari A, Ranjan A, Nishant P, Sinha S, Sinha RK. Cross-sectional study to describe the severity, bio-chemical associations, and final outcomes of COVID-19-associated rhino-orbital-cerebral mucormycosis in a tertiary hospital of East India. Indian J Ophthalmol 2023; 71:2193-2198. [PMID: 37202947 PMCID: PMC10391476 DOI: 10.4103/ijo.ijo_2507_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose The second wave of coronavirus disease 2019 (COVID-19) pandemic triggered a mucormycosis epidemic in India. Diabetes mellitus and dysregulated immune response were contributors, and rhino-orbital-cerebral mucormycosis (ROCM) was the most common presentation. It is however not known whether bio-chemical parameters at presentation correlate with stage of ROCM or final outcome in terms of vision or mortality. Methods This retrospective, hospital-based study included all in-patients of mucormycosis with ophthalmic manifestations at presentation admitted during June 1, 2021 to August 31, 2021. It aimed to evaluate the association between severity of infection, serum levels of HbA1c, ferritin, interleukin-6 (IL-6), C-reactive protein (CRP), and D-dimer levels at presentation and outcome. Results There were altogether 47 eligible cases having a mean age of 48.8 ± 10.9 years with a male:female ratio of 2.6:1; forty-two (89.4%) had pre-existing diabetes, and five (10.6%) had steroid-induced hyperglycemia. The mean HbA1c among diabetics was 9.7 ± 2.1. HbA1c and serum CRP showed an increase over subsequent stages, which was not statistically significant (P = 0.31). IL-6 values for all stages were similar (P = 0.97). Only serum ferritin levels showed a statistically significant increase over stages (P = 0.04). IL-6 was significantly lower (P = 0.03) in patients who survived, whereas CRP levels were significantly lower in patients who had final visual acuity (VA) better than only perception of light (P = 0.03). Conclusion Uncontrolled diabetes mellitus is a significant association of ROCM. Serum ferritin levels at presentation best correlate with extent of the disease. CRP levels are best to prognosticate cases that will have sufficient VA to carry on activities of daily living, whereas IL-6 levels are best associated with survival.
Collapse
Affiliation(s)
- Abhilasha Kumari
- Department of Ophthalmology, Patna Medical College, Patna, India
| | - Alok Ranjan
- Department of Ophthalmology, Patna Medical College, Patna, India
| | - Prateek Nishant
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, India
| | - Sony Sinha
- Department of Ophthalmology, Patna Medical College, Patna, India
| | - Ranjeet K Sinha
- Department of Community Medicine, Patna Medical College, Patna, India
| |
Collapse
|
10
|
Hasegawa N, Zhao J, Greninger DA, Lu J, Yoon MK, Chen Y, McCulley TJ. An orbital calcific cyst following exenteration. Orbit 2022:1-4. [PMID: 36573493 DOI: 10.1080/01676830.2022.2151630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/20/2022] [Indexed: 02/17/2024]
Abstract
A 77-year-old Asian female with a history of left orbit exenteration and lid-sparing reconstruction for recurrent sebaceous carcinoma presented with fluid-like sensation of the left orbit. Magnetic resonance imaging (MRI) demonstrated bright T2 signal and a cyst-like cavity within the exenterated orbit. Decision was made to proceed with surgical exploration and excision. A calcified, bone-like cavity was encountered intraoperatively and removed. Histopathology revealed dense fibrous connective tissue with areas of calcification without osseous metaplasia, suggestive of retained blood in the orbit that underwent dystrophic calcification. This case report illustrates a rare occurrence of a bone-like calcific cyst following exenteration.
Collapse
Affiliation(s)
- Naomi Hasegawa
- Department of Ophthalmology, University of Texas at Houston, Houston, Texas, USA
| | - Jiawei Zhao
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel A Greninger
- Department of Ophthalmology, Kaiser Permanente Antioch Medical Center, Antioch, California, USA
| | - Jonathan Lu
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Ying Chen
- Department of Ophthalmology, University of Texas at Houston, Houston, Texas, USA
| | - Timothy J McCulley
- Department of Ophthalmology, University of Texas at Houston, Houston, Texas, USA
| |
Collapse
|
11
|
Azad F, Schiff J, Macias R, O'Toole T, Cheung VWF. Live Donation of Corneal Tissue in the Setting of Orbital Exenteration for Malignancy. Eplasty 2022; 22:e17. [PMID: 35873070 PMCID: PMC9275411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background. The availability of corneal tissue is a major limiting factor in utilizing keratoplasty for correction of corneal blindness. Viable corneal tissue is typically difficult to obtain as posthumous donation is required to avoid significant morbidity and loss of vision in live patients. As a result, the possibility of obtaining viable corneal tissue from a living donor is rarely discussed. This report describes a case in which corneal donation was completed in a living patient undergoing exenteration for invasive squamous cell carcinoma of the maxillary sinus. Performing corneal donation in similar patients in the future should be considered by head and neck surgeons as an opportunity to increase the availability of corneal tissue.
Collapse
Affiliation(s)
- Fereshteh Azad
- Kresge Eye Institute, MI
- Spectrum Health, Grand Rapids, MI
| | - Jonathan Schiff
- Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Rachel Macias
- Spectrum Health Plastic Surgery Residency, Grand Rapids, MI
| | | | | |
Collapse
|
12
|
Naurka S, Rana N, Singh N, Kishore A, Nagpal K. COVID-19 associated rhino-orbital-cerebral mucormycosis-an institutional series. Ear Nose Throat J 2022:1455613221077882. [PMID: 35176884 PMCID: PMC8859478 DOI: 10.1177/01455613221077882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mucormycosis is almost always confined to the patients with altered host defenses amongst which diabetes is considered as the strongest risk factor. COVID-19 only been seen in severe cases but also in mild and moderate cases of SARS-CoV-2 infections. After preliminary clinical and radiological diagnosis, surgical management in the form of endoscopic sinus surgery, debridement, and orbital exenteration (8) was performed. Medical management in the form of antifungal therapy (amphotericin-B, posaconazole, and isavuconazole) was initiated. In this case series, 79 proven cases of COVID-19 associated rhino-orbital-cerebral mucormycosis were analyzed retrospectively from mid-April 2021 to mid-September 2021. 67 patients were known diabetics, whereas rest 12 had new onset diabetes mellitus. Of these 79 cases, 27 cases had the disease limited to sinuses (rhino-mucormycosis), 43 had orbital involvement also (rhino-orbital mucormycosis), and 9 had cerebral involvement as well (rhino-orbital-cerebral mucormycosis). During this time-period, a total of 14 mortalities occurred. Most of the patients were discharged after completion of amphotericin-B therapy and rest stayed little longer till their general condition improved. COVID-19 causes dysregulation and alteration of immune response in the body which predispose to invasive fungal infections. In addition, uncontrolled diabetes mellitus and corticosteroid treatment increase the risk of mucormycosis by many folds.
Collapse
Affiliation(s)
| | - Nishant Rana
- ENT, Indraprastha Apollo Hospital, New Delhi, India
| | - Neeraj Singh
- Maxillofacial Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | | | | |
Collapse
|
13
|
Ma R, Li X, Gan L, Guo J, Qian J. Modified procedure of anterior orbital exenteration enables eye socket reconstruction: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e28698. [PMID: 35089227 PMCID: PMC8797479 DOI: 10.1097/md.0000000000028698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/10/2022] [Indexed: 01/05/2023] Open
Abstract
The conventional procedure of anterior orbital exenteration is unfavorable for eye socket reconstruction, whereas a modified procedure enables socket reconstruction and prosthesis fitting. Our study aims to compare the cosmetic outcomes between these 2 surgical techniques.We retrospectively recruited patients treated with modified or conventional exenteration during January 2015 to May 2021 in our hospital. The conventional approach was performed along with dermis-fat graft transplantation. The modified approach was conducted followed by eye socket reconstruction and eyelid blepharoplasty. The clinical data were collected and analyzed, including demographics, tumor characteristics, postoperative complications, tumor-related events, and cosmetic outcomes.Forty-nine patients were consecutively recruited in this study, including 22 cases of modified exenteration and 27 cases of conventional exenteration. Forty-four subjects (89.8%) were diagnosed with ocular surface malignancies (conjunctival melanoma and squamous cell carcinoma) and 5 subjects (10.2%) were diagnosed with extraocular stage of uveal melanoma. After follow-up for 31.8 ± 17.1 months, the 1-, 2-, 5-year overall survival rate was calculated as 100%, 79.2%, and 59.2% in the Modified group, and 94.2%, 73.8%, and 51.5% in the Conventional group. Comparison of the survival curves showed no significant differences. In the Modified group, all patients received orbital implant placement and eye socket reconstruction. The implant motility was satisfactory in 12 cases (54.5%) with movements in 3 to 4 directions. The eyelid function was acceptable in 17 cases (77.3%) with no entropion, ectropion or lower lid laxity. Ocular prosthesis was delivered in 17 cases (77.3%) with successful fitting in 11 cases (64.7%). The self-rated cosmetic score was statistically (t test, P < .0001) higher in the Modified group (6.7 ± 0.9) than the Conventional group (2.2 ± 0.4).The modified approach to anterior orbital exenteration enables eye socket reconstruction and cosmetic rehabilitation while still preserves the curable chance for the treatment of advanced periocular/intraocular malignancies.
Collapse
Affiliation(s)
- Ruiqi Ma
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaofeng Li
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Lu Gan
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jie Guo
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Jiang Qian
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China
| |
Collapse
|
14
|
Pap I, Jakab-Péter K, Uzsaly J, Tóth I, Barabás MA, Fábián G, Lujber L. Transorbito-maxillary percutaneous endoscopic gastrostomy. Orv Hetil 2022; 163:116-119. [PMID: 35034010 DOI: 10.1556/650.2022.32286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Fej-nyaki daganattal diagnosztizált és kezelt betegeknél a szájon keresztüli táplálás gyakran nem lehetséges vagy nehezítetté válik a kezelés valamelyik fázisában. A beteg enteralis táplálásának biztosítására tartós és hatékony megoldást kell nyújtanunk, erre megfelelő választás lehet a percutan endoszkópos gastrostomia. A fej-nyaki régióban a daganat elhelyezkedése, kiterjedtsége és a műtétek miatt megváltozott anatómiai viszonyok sokszor gátat szabnak a gasztroszkóp hagyományos, szájon át történő sikeres levezetésének, és így különleges megoldásokra lehet szükség. Közleményünkben egy, a szakirodalomban is ritkán alkalmazott percutan endoszkópos gastrostomakészítésről számolunk be. A bemutatott esetben egy kiterjedt, rosszindulatú fej-nyaki daganat miatt totális maxillectomián és orbitaexenteratión átesett betegben a műtét következtében kialakult arcdefektuson át történt a gastroscopia és a tápszonda levezetése, ugyanis komplett szájzár következtében a beteg a táplálkozásra képtelen volt. A fent említett módszerrel sikerült a beteg hosszú távú enteralis táplálását megoldani minimálinvazív módon. Az összetett kóros esetek gyakran állítják kihívások elé a gyakorló klinikust. Esetbemutatásunkkal szeretnénk felhívni a figyelmet a hagyományos, megszokott módszerek helyett sokszor nagyobb sikerrel alkalmazható, személyre szabott terápiás lehetőségekre. Orv Hetil. 2022; 163(3): 116-119. Summary. Peroral, enteral feeding is often impossible in patients with head and neck cancer. Percutaneous endoscopic gastrostomy is a well-established, quick, minimally invasive, and safe procedure for providing long-term enteral feeding. Space-occupying tumour mass and altered anatomy due to surgery inhibit the gastroscope's peroral introduction and the feeding tube's placement in some instances. Various access routes and modified insertion techniques are recommended to overcome the feeding tube insertion challenges. We present a rare case of a 64-year-old head and neck cancer patient who was unable to eat orally due to trismus and had a facial soft tissue defect following total maxillectomy and orbital exenteration. A complete oesophago-gastro-duodenoscopy and feeding tube insertion were performed transfacially. Percutaneous endoscopic gastrostomy was successful and uneventful via the maxillary and orbital soft tissue facial defect. No complication was noted, and long-term enteral feeding of the patient was provided in a minimally invasive way. Surgeons often face challenging cases when treating patients with head and neck cancer. The modification of standard procedures is sometimes required to adapt surgical techniques to the patient's specific case. Orv Hetil. 2022; 163(3): 116-119.
Collapse
Affiliation(s)
- István Pap
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Fül-, Orr-, Gégészeti és Fej-, Nyaksebészeti Klinika Pécs, Munkácsy M. u. 2., 7621
| | - Kinga Jakab-Péter
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Fül-, Orr-, Gégészeti és Fej-, Nyaksebészeti Klinika Pécs, Munkácsy M. u. 2., 7621
| | - János Uzsaly
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Fül-, Orr-, Gégészeti és Fej-, Nyaksebészeti Klinika Pécs, Munkácsy M. u. 2., 7621
| | - István Tóth
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Fül-, Orr-, Gégészeti és Fej-, Nyaksebészeti Klinika Pécs, Munkácsy M. u. 2., 7621
| | | | - György Fábián
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, II. Belgyógyászati Klinika és Nephrológiai, Diabetológiai Centrum Pécs
| | - László Lujber
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Fül-, Orr-, Gégészeti és Fej-, Nyaksebészeti Klinika Pécs, Munkácsy M. u. 2., 7621
| |
Collapse
|
15
|
Palmisciano P, Ferini G, Ogasawara C, Wahood W, Bin Alamer O, Gupta AD, Scalia G, Larsen AMG, Yu K, Umana GE, Cohen-Gadol AA, El Ahmadieh TY, Haider AS. Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes. Cancers (Basel) 2021; 14:94. [PMID: 35008259 PMCID: PMC8750198 DOI: 10.3390/cancers14010094] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Orbital metastases often lead to severe functional impairment. The role of resection, orbital exenteration, and complementary treatments is still debated. We systematically reviewed the literature on orbital metastases. METHODS PubMed, Scopus, Web-of-Science, and Cochrane were searched upon PRISMA guidelines to identify studies on orbital metastases. Clinical characteristics, management strategies, and survival were analyzed. RESULTS We included 262 studies comprising 873 patients. Median age was 59 years. The most frequent primary tumors were breast (36.3%), melanoma (10.1%), and prostate (8.5%) cancers, with median time interval of 12 months (range, 0-420). The most common symptoms were proptosis (52.3%) and relative-afferent-pupillary-defect (38.7%). Most metastases showed a diffuse location within the orbit (19%), with preferential infiltration of orbital soft tissues (40.2%). In 47 cases (5.4%), tumors extended intracranially. Incisional biopsy (63.7%) was preferred over fine-needle aspiration (10.2%), with partial resection (16.6%) preferred over complete (9.5%). Orbital exenteration was pursued in 26 patients (3%). A total of 305 patients (39.4%) received chemotherapy, and 506 (58%) received orbital radiotherapy. Post-treatment symptom improvement was significantly superior after resection (p = 0.005) and orbital radiotherapy (p = 0.032). Mean follow-up was 14.3 months, and median overall survival was 6 months. Fifteen cases (1.7%) demonstrated recurrence with median local control of six months. Overall survival was statistically increased in patients with breast cancer (p < 0.001) and in patients undergoing resection (p = 0.024) but was not correlated with orbital location (p = 0.174), intracranial extension (p = 0.073), biopsy approach (p = 0.344), extent-of-resection (p = 0.429), or orbital exenteration (p = 0.153). CONCLUSIONS Orbital metastases severely impair patient quality of life. Surgical resection safely provides symptom and survival benefit compared to biopsy, while orbital radiotherapy significantly improves symptoms compared to not receiving radiotherapy.
Collapse
Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, 95029 Viagrande, Italy;
| | - Christian Ogasawara
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA;
| | - Waseem Wahood
- Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL 33328, USA;
| | - Othman Bin Alamer
- Department of Neurosurgery, King Abdullah International Medical Research Center, Riyadh 11451, Saudi Arabia;
| | - Aditya D. Gupta
- College of Medicine, Texas A&M University, Houston, TX 77030, USA; (A.D.G.); (A.S.H.)
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95126 Catania, Italy;
| | - Alexandra M. G. Larsen
- Department of Neurosurgery, Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.M.G.L.); (K.Y.); (T.Y.E.A.)
| | - Kenny Yu
- Department of Neurosurgery, Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.M.G.L.); (K.Y.); (T.Y.E.A.)
| | - Giuseppe E. Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Aaron A. Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46077, USA;
| | - Tarek Y. El Ahmadieh
- Department of Neurosurgery, Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.M.G.L.); (K.Y.); (T.Y.E.A.)
| | - Ali S. Haider
- College of Medicine, Texas A&M University, Houston, TX 77030, USA; (A.D.G.); (A.S.H.)
- Department of Neurosurgery, Anderson Cancer Center, The University of Texas M.D., Houston, TX 77030, USA
| |
Collapse
|
16
|
Nahon-Estève S, Bertolotto C, Picard-Gauci A, Gastaud L, Baillif S, Hofman P, Groulier A, Maschi C, Caujolle JP, Lassalle S, Martel A. Small but Challenging Conjunctival Melanoma: New Insights, Paradigms and Future Perspectives. Cancers (Basel) 2021; 13:5691. [PMID: 34830847 PMCID: PMC8616295 DOI: 10.3390/cancers13225691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Although its incidence has increased over the last decades, conjunctival melanoma (CM) remains a rare but challenging periocular malignancy. While there is currently no recognized standard of care, "no-touch" surgical excision followed by adjuvant treatments is usually recommended. Despite its small size, managing CM is challenging for clinicians. The first challenge is the high risk of tumour local recurrence that occurs in about one third of the patients. The management of locally advanced CM (≥T2) or multiple recurrences may require mutilating surgeries such as orbital exenteration (OE). The second challenge is the metastatic spread of CM that occurs in about one quarter of patients, regardless of whether complete surgical excision is performed or not. This highlights the infiltrative and highly aggressive behaviour of CM. Recently, attention has been directed towards the use of eye-sparing strategies to avoid OE. Initially, wide conservative surgeries followed by customized brachytherapy or radiotherapy have appeared as viable strategies. Nowadays, new biological insights into CM have revealed similarities with cutaneous melanoma. These new findings have allowed clinicians to reconsider the management of locally advanced CM with "medical" eye-sparing treatment as well as the management of metastatic spread. The aim of this review was to summarize the current and future perspectives of treatment for CM based on recent biological findings.
Collapse
Affiliation(s)
- Sacha Nahon-Estève
- Ophthalmology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (S.B.); (C.M.); (J.-P.C.); (A.M.)
- Department of Biology and Pathologies of Melanocytes, Team1, Equipe Labellisée Ligue 2020 and Equipe Labellisée ARC 2019, Centre Méditerranéen de Médecine Moléculaire, INSERM, 06200 Nice, France;
| | - Corine Bertolotto
- Department of Biology and Pathologies of Melanocytes, Team1, Equipe Labellisée Ligue 2020 and Equipe Labellisée ARC 2019, Centre Méditerranéen de Médecine Moléculaire, INSERM, 06200 Nice, France;
| | - Alexandra Picard-Gauci
- Dermatology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France;
| | - Lauris Gastaud
- Antoine Lacassagne Cancer Centre, Oncology Department, Université Côte d’Azur, 06000 Nice, France;
| | - Stéphanie Baillif
- Ophthalmology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (S.B.); (C.M.); (J.-P.C.); (A.M.)
| | - Paul Hofman
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Université Côte d’Azur, 06000 Nice, France; (P.H.); (S.L.)
- Biobank BB-0033-00025, Laboratory of Clinical and Experimental Pathology, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France
| | - Anaïs Groulier
- Antoine Lacassagne Cancer Center, Department of Radiation Oncology, Université Côte d’Azur, 06000 Nice, France;
| | - Célia Maschi
- Ophthalmology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (S.B.); (C.M.); (J.-P.C.); (A.M.)
| | - Jean-Pierre Caujolle
- Ophthalmology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (S.B.); (C.M.); (J.-P.C.); (A.M.)
| | - Sandra Lassalle
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Université Côte d’Azur, 06000 Nice, France; (P.H.); (S.L.)
- Biobank BB-0033-00025, Laboratory of Clinical and Experimental Pathology, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France
| | - Arnaud Martel
- Ophthalmology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (S.B.); (C.M.); (J.-P.C.); (A.M.)
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Université Côte d’Azur, 06000 Nice, France; (P.H.); (S.L.)
| |
Collapse
|
17
|
Singh A, Panyala R, Irfan KSA, Samanta R, Kumar B. An Unusual Presentation of Retrobulbar Cavernous Hemangioma in a Young Woman. Cureus 2021; 13:e17508. [PMID: 34603884 PMCID: PMC8476192 DOI: 10.7759/cureus.17508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 12/05/2022] Open
Abstract
A 38-year-old woman presented with sudden-onset painful lid swelling, proptosis and external ophthalmoplegia on the right side for 20 days, associated with loss of vision for nine days. On contrast-enhanced computed tomography (CECT), a retrobulbar mass was noted involving intraconal and extraconal spaces, extending up to the orbital foramina with enhancement and thickening of meninges. CT arteriography further revealed multiple feeding vessels from the maxillary artery. Embolization of feeding vessels followed by right orbital exenteration with primary reconstruction using forehead flap was done. This is an unusual case of orbital cavernous hemangioma (OCH) which emphasizes the importance of CT arteriography in specific cases of OCH, where routine neuroimaging may be inconclusive.
Collapse
Affiliation(s)
- Anupam Singh
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Rakesh Panyala
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Khan Shama A Irfan
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Ramanuj Samanta
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Barun Kumar
- Cardiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| |
Collapse
|
18
|
Lilly G, Geltzeiler M. Induction Chemotherapy for Orbit Preservation in Sinonasal Squamous Cell Carcinoma. J Neurol Surg Rep 2021; 82:e36-e37. [PMID: 34603932 PMCID: PMC8481003 DOI: 10.1055/s-0041-1736160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/13/2021] [Indexed: 11/03/2022] Open
Abstract
Sinonasal squamous cell carcinoma (SNSCC) is a rare and aggressive malignancy which often presents at an advanced stage. The gold-standard treatment includes negative-margin surgical resection plus adjuvant therapy. In cases of orbital invasion, surgery requires orbital exenteration which can carry significant morbidity and result in decreased quality of life. In selected patients, induction chemotherapy (IC) can allow for orbit preservation without compromising oncologic outcomes. The available literature will be briefly discussed.
Collapse
Affiliation(s)
- Gabriela Lilly
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, United States
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, United States
| |
Collapse
|
19
|
Ahuja A, Samudra M, Prasad SP, Chaudhury S, Bora S, Singh V, Dhore N. Correlates of depression, anxiety, self-esteem, and suicidal ideas in COVID-associated mucormycosis patients and the effects of treatment. Ind Psychiatry J 2021; 30:S75-S82. [PMID: 34908669 PMCID: PMC8611535 DOI: 10.4103/0972-6748.328863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 01/17/2023] Open
Abstract
AIM The aim was to study the correlates of depression, anxiety, self-esteem, and suicidal ideas in patients of COVID-associated mucormycosis (CAM) and effects of treatment. MATERIALS AND METHODS A cross-sectional, analytical study was performed in a tertiary care center in Western Maharashtra. By purposive sampling, 34 patients of CAM were included in the study with their informed consent and after obtaining ethical clearance. A self-made questionnaire to include demographic and clinical details was filled. Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale (RSES), and Suicidal Ideation Attributes Scale (SIDAS) were applied after initial diagnosis. The HADS, RSES, and SIDAS were reapplied after their operative treatment. RESULTS A significant reduction in anxiety and depression scores postoperatively was seen. No significant difference was found in self-esteem or suicidal ideas postoperatively in the study population. However, patients who underwent orbital exenteration showed a significant reduction in level of self-esteem with anxiety and depression postoperatively. No specific correlation was found between the computed tomography score, family history, intensive care unit admission, or orbital exenteration with anxiety, depression, self-esteem, and suicidal ideas. CONCLUSION Levels of anxiety and depression in patients of CAM reduced significantly after treatment, but self-esteem worsened in males more than females owing to disfigurement. There is a need of psychological counseling in patients of mucormycosis undergoing a debilitating surgery both pre- and postoperatively for a better outcome and recovery.
Collapse
Affiliation(s)
- Amod Ahuja
- Department of Ophthalmology, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Madhura Samudra
- Department of Psychiatry, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Shashi Prabha Prasad
- Department of Ophthalmology, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Shivangi Bora
- Department of Ophthalmology, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Varsha Singh
- Department of Ophthalmology, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| | - Nilay Dhore
- Department of Ophthalmology, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
| |
Collapse
|
20
|
Prídavková Z, Bieliková A, Ferková N, Lysková D. RECURRENT PERIOCULAR BASAL CELL CARCINOMA. CASE REPORT. Cesk Slov Oftalmol 2021; 77:208-213. [PMID: 34507497 DOI: 10.31348/2021/24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM We present the management of a severe case of recurrent periocular basal cell carcinoma, orbital invasion and exenteration. CASE REPORT The present case is of a recurrent basal cell carcinoma in a 84-year-old male presenting with non-healing lesion above right eyelid. A tumor excision was performed in May 2014. Histopathology revealed a basal cell carcinoma (dg. C44.1 ICD-10-CM) with positive margins. The re-excision of the lesion was performed. After two years, there was a local recurrence and orbital invasion. Indication for external curative radiation therapy. Plastic surgery of the upper eyelid. Orbital exenteration was indicated in January 2018. After another year, a recurrence of the tumor was once again noted. Histopathology revealed a basal cell carcinoma (dg. C44.1 (TNM 7, pMx, pNx, pTx)). The patient was indicated for external radiotherapy. There were no indications for biological treatment. After another year, a progression of the local finding was noted. CONCLUSION Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer of the periocular region. Primary treatment of basal cell carcinoma is surgical. Advanced lesions require extensive surgical interventions and other available treatment modalities. In some cases, mutilating surgery - exenteration of the orbit is inevitable. Despite a relatively small percentage of invasive diseases today, advanced stages may still occur; either as a result of the patient's late presentation, inadequate initial therapy aimed at maintaining critical periorbital structures, or due to high tumor aggression. The case report highlights necessity of radical resection of primary tumor with histological examination.
Collapse
|
21
|
Abstract
Orbital exenteration is a radical surgery which involves complete removal of the orbital contents along with all or parts of the eyelid. However, the eyelid complex can be totally spared in cases of necrotising disease such as mucormycosis without compromising on exposure, or fear of devascularisation of the lids. We describe a total eyelid complex preserving orbital exenteration. Preservation of the total eyelid complex has the potential to speed up the healing process and provide dynamic functional and cosmetic rehabilitation.
Collapse
Affiliation(s)
- Pawan Agarwal
- Professor and In Charge Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - D Sharma
- Professor and Head, Department of Surgery, NSCB Government Medical College, Jabalpur, India
| |
Collapse
|
22
|
Castelnuovo P, Lambertoni A, Sileo G, Valentini M, Karligkiotis A, Battaglia P, Turri-Zanoni M. Critical review of multidisciplinary approaches for managing sinonasal tumors with orbital involvement. ACTA ACUST UNITED AC 2021; 41:S76-S89. [PMID: 34060523 PMCID: PMC8172109 DOI: 10.14639/0392-100x-suppl.1-41-2021-08] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/04/2021] [Indexed: 02/03/2023]
Abstract
Orbital invasion is frequently observed in tumors involving the maxillary, ethmoid and frontal sinuses given the proximity of the orbit to the sinonasal tract and ventral skull base. The main objective of the present review is to determine the existing evidences on the frequency, treatment, and outcomes of orbital invasion in benign and malignant sinonasal tumors. A systematic review of the literature published from 1995 to 2020 was performed and data sources included PubMed, Cochrane library, NCBI Bookshelf, National Guideline Clearinghouse. Orbital invasion was reported in 2-4% of inverted papillomas, 12-15% of fibro-osseous lesions, 27-32% of juvenile angiofibromas, 35-45% of low-grade malignancies, and 50-80% of high-grade cancers. Surgical resection with negative margins represents the cornerstone of management for benign and low-grade malignant tumors. Histology-specific induction chemotherapy can be used for high-grade sinonasal cancers in order to downstage the tumor and increase the possibility of orbital preservation. When a significant response to induction chemotherapy is observed, exclusive chemoradiation should be offered to improve overall survival rates. Appropriate reconstruction of any surgical defects is essential in order to minimize complications and optimize functional and aesthetic outcomes. Orbital apex invasion represents a negative prognostic factor. In conclusion, a multidisciplinary teamwork is mandatory to maximize local control, minimize morbidity and improve orbital preservation rates.
Collapse
Affiliation(s)
- 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
| | - Alessia Lambertoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giorgio Sileo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marco Valentini
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, 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 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
| |
Collapse
|
23
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
24
|
Sen M, Honavar SG, Bansal R, Sengupta S, Rao R, Kim U, Sharma M, Sachdev M, Grover AK, Surve A, Budharapu A, Ramadhin AK, Tripathi AK, Gupta A, Bhargava A, Sahu A, Khairnar A, Kochar A, Madhavani A, Shrivastava AK, Desai AK, Paul A, Ayyar A, Bhatnagar A, Singhal A, Nikose AS, Bhargava A, Tenagi AL, Kamble A, Nariani A, Patel B, Kashyap B, Dhawan B, Vohra B, Mandke C, Thrishulamurthy C, Sambare C, Sarkar D, Mankad DS, Maheshwari D, Lalwani D, Kanani D, Patel D, Manjandavida FP, Godhani F, Agarwal GA, Ravulaparthi G, Shilpa GV, Deshpande G, Thakkar H, Shah H, Ojha HR, Jani H, Gontia J, Mishrikotkar JP, Likhari K, Prajapati K, Porwal K, Koka K, Dharawat KS, Ramamurthy LB, Bhattacharyya M, Saini M, Christy MC, Das M, Hada M, Panchal M, Pandharpurkar M, Ali MO, Porwal M, Gangashetappa N, Mehrotra N, Bijlani N, Gajendragadkar N, Nagarkar NM, Modi P, Rewri P, Sao P, Patil PS, Giri P, Kapadia P, Yadav P, Bhagat P, Parekh R, Dyaberi R, Chauhan RS, Kaur R, Duvesh RK, Murthy R, Dandu RV, Kathiara R, Beri R, Pandit R, Rani RH, Gupta R, Pherwani R, Sapkal R, Mehta R, Tadepalli S, Fatima S, Karmarkar S, Patil SS, Shah S, Shah S, Shah S, Dubey S, Gandhi S, Kanakpur S, Mohan S, Bhomaj S, Kerkar S, Jariwala S, Sahu S, Tara S, Maru SK, Jhavar S, Sharma S, Gupta S, Kumari S, Das S, Menon S, Burkule S, Nisar SP, Kaliaperumal S, Rao S, Pakrasi S, Rathod S, Biradar SG, Kumar S, Dutt S, Bansal S, Ravani SA, Lohiya S, Rizvi SWA, Gokhale T, Lahane TP, Vukkadala T, Grover T, Bhesaniya T, Chawla U, Singh U, Une VL, Nandedkar V, Subramaniam V, Eswaran V, Chaudhary VN, Rangarajan V, Dehane V, Sahasrabudhe VM, Sowjanya Y, Tupkary Y, Phadke Y. Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1. Indian J Ophthalmol 2021; 69:1670-1692. [PMID: 34156034 PMCID: PMC8374756 DOI: 10.4103/ijo.ijo_1565_21] [Citation(s) in RCA: 201] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion : Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.
Collapse
Affiliation(s)
| | | | | | | | - Raksha Rao
- Narayana Netralaya, Bengaluru, Karnataka, India
| | - Usha Kim
- Aravind Eye Care, Madurai, Tamil Nadu, India
| | | | | | - Ashok K Grover
- Department of Ophthalmology, Sir Ganga Ram Hospital and Vision Eye Centres, New Delhi, India
| | - Abhidnya Surve
- Department of Ophthalmology, Dr. Hedgewar Rugnalaya, Aurangabad, Maharashtra, India
| | - Abhishek Budharapu
- Department of Head and Neck Surgery, Apollo Cancer Hospital, Hyderabad, Telangana, India
| | - Abhishek K Ramadhin
- Department of Otorhinolaryngology, Dr Abhishek K. Ramadhin Hospital and Avyaan Research Centre, Ranchi, Jharkhand, India
| | | | - Adit Gupta
- Mumbai Eye Plastic Surgery, Maharashtra, India
| | - Aditya Bhargava
- Department of Otorhinolaryngology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Animesh Sahu
- Retina Speciality Hospital, Indore, Madhya Pradesh, India
| | - Anjali Khairnar
- Department of Ophthalmology, Shree Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - Anju Kochar
- Department of Ophthalmology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Ankita Madhavani
- Department of Ophthalmology, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat, India
| | - Ankur K Shrivastava
- Department of Ophthalmology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Anuja K Desai
- Department of Ophthalmology, Kusum Dhirajlal Hospital, Ahmedabad, Gujarat, India
| | - Anujeet Paul
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | | | - Aparna Bhatnagar
- Department of Ophthalmology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | - Aparna Singhal
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Archana Sunil Nikose
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, Maharashtra, India
| | - Arun Bhargava
- Retina Speciality Hospital, Indore, Madhya Pradesh, India
| | - Arvind L Tenagi
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Karnataka Lingayat Education Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Ashish Kamble
- Department of Ophthalmology, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Ashiyana Nariani
- Department of Ophthalmology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Bhavin Patel
- Department of Otorhinolaryngology, Kiran Super Multi-Speciality Hospital, Surat, Gujarat, India
| | | | - Bodhraj Dhawan
- Department of Ophthalmology, Alexis Hospital, Nagpur, Maharashtra, India
| | - Busaraben Vohra
- Department of Ophthalmology, Medical College Baroda and Sir Sayajirao General Hospital, Vadodara, Gujarat, India
| | - Charuta Mandke
- Department of Ophthalmology, Hinduhridaysamrat Balasaheb Thackeray Medical College & Dr. R. N. Cooper Municipal Hospital, Mumbai, Maharashtra, India
| | - Chinmayee Thrishulamurthy
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Chitra Sambare
- Department of Ophthalmology, Jehangir Hospital, Pune, Maharashtra, India
| | - Deepayan Sarkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | | - Dhwani Maheshwari
- Department of Ophthalmology, Sir Sayajirao Gaekwad Hospital, Vadodra, Gujarat, India
| | | | - Dipti Kanani
- Department of Ophthalmology, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat, India
| | - Diti Patel
- Department of Ophthalmology, Medical College Baroda and Sir Sayajirao General Hospital, Vadodara, Gujarat, India
| | | | - Frenali Godhani
- Department of Ophthalmology, Jagjivan Ram Railway Hospital, Mumbai, Maharashtra, India
| | - Garima Amol Agarwal
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Gayatri Ravulaparthi
- Department of Ophthalmology, Mamata Academy of Medical Sciences, Hyderabad, Telangana, India
| | | | | | - Hansa Thakkar
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Hardik Shah
- Department of Otorhinolaryngology, Kusum Dhirajlal Hospital, Ahmedabad, Gujarat, India
| | | | - Harsha Jani
- Department of Ophthalmology, Pramukh Swami Medical College, Karamsad, Gujarat, India
| | - Jyoti Gontia
- Department of Ophthalmology, Maharaja Yeshwantrao Hospital, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Jyotika P Mishrikotkar
- Department of Ophthalmology, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, Maharashtra, India
| | | | - Kamini Prajapati
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Kavita Porwal
- Department of Ophthalmology, Convenient Hospitals Limited (CHL) – Hospitals, Indore, Madhya Pradesh, India
| | - Kirthi Koka
- Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Lakshmi B Ramamurthy
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | | | - Manorama Saini
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | | | - Mausumi Das
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Maya Hada
- Department of Ophthalmology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Mehul Panchal
- Department of Microbiology, Kiran Super Multi-Speciality Hospital, Surat, Gujarat, India
| | | | | | | | - Nagaraju Gangashetappa
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Neelima Mehrotra
- Department of Ophthalmology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Neha Bijlani
- Vision Care & Research Centre, Bhopal, Madhya Pradesh, India
| | | | - Nitin M Nagarkar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Palak Modi
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Parveen Rewri
- Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Piyushi Sao
- Department of Ophthalmology, Shri Mallanagouda Basanagouda Patil Medical College, BLDE University, Vijayapura, Karnataka, India
| | - Prajakta Salunkhe Patil
- Department of Ophthalmology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Pramod Giri
- Max Vision Eye Hospital, Nagpur, Maharashtra, India
| | - Priti Kapadia
- Department of Ophthalmology, Government Medical College, Surat, Gujarat, India
| | - Priti Yadav
- Department of Ophthalmology, Maharaja Yeshwantrao Hospital, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Purvi Bhagat
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Ragini Parekh
- Department of Ophthalmology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, Maharashtra, India
| | - Rajashekhar Dyaberi
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Rajender Singh Chauhan
- Regional Institute of Ophthalmology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rajwinder Kaur
- Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bhatinda, Punjab, India
| | - Ram Kishan Duvesh
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Ravi Varma Dandu
- Department of Neuroradiology, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Ravija Kathiara
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Renu Beri
- Department of Ophthalmology, Civil Hospital Ambala Cantonment, Haryana, India
| | - Rinal Pandit
- Department of Ophthalmology, Choithram Hospital & Research Centre, Indore, Madhya Pradesh, India
| | - Rita Hepsi Rani
- Department of Ophthalmology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India
| | | | - Ruchi Pherwani
- Department of Ophthalmology, SMBT Institute of Medical Sciences and Research Centre, Nashik, Maharashtra, India
| | - Rujuta Sapkal
- Department of Ophthalmology, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, Maharashtra, India
| | - Rupa Mehta
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Sameeksha Tadepalli
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Samra Fatima
- Sarojini Devi Eye Hospital, Hyderabad, Telangana, India
| | - Sandeep Karmarkar
- Department of Otorhinolaryngology, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | - Sanjana Shah
- Department of Ophthalmology, Medical College Baroda and Sir Sayajirao General Hospital, Vadodara, Gujarat, India
| | - Sankit Shah
- Department of Ophthalmology, Kiran Super Multi-Speciality Hospital, Surat, Gujarat, India
| | - Sapan Shah
- Department of Ophthalmology, Kusum Dhirajlal Hospital, Ahmedabad, Gujarat, India
| | - Sarika Dubey
- Department of Ophthalmology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | | | - Savitha Kanakpur
- Department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Shalini Mohan
- Department of Ophthalmology, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India
| | | | - Sheela Kerkar
- Department of Ophthalmology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Shivani Jariwala
- Department of Ophthalmology, Government Medical College, Surat, Gujarat, India
| | - Shivati Sahu
- Department of Ophthalmology, Maharaja Yeshwantrao Hospital, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | | | - Shruti Kochar Maru
- Department of Ophthalmology, Convenient Hospitals Limited (CHL) – Hospitals, Indore, Madhya Pradesh, India
| | - Shubha Jhavar
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
| | - Shubhda Sharma
- Department of Ophthalmology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Shweta Gupta
- Sankara Eye Foundation, Indore, Madhya Pradesh, India
| | - Shwetha Kumari
- Department of Ophthalmology, Bowring and Lady Curzon Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sima Das
- Dr. Shroff Charity Eye Hospital, New Delhi, India
| | - Smita Menon
- Department of Ophthalmology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
| | - Snehal Burkule
- Department of Ophthalmology, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
| | | | - Subashini Kaliaperumal
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Subramanya Rao
- Department of Otorhinolaryngology, Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | - Sudipto Pakrasi
- Department of Ophthalmology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Sujatha Rathod
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sunil G Biradar
- Department of Ophthalmology, Shri Mallanagouda Basanagouda Patil Medical College, BLDE University, Vijayapura, Karnataka, India
| | - Suresh Kumar
- Department of Ophthalmology, Government Medical College, Chandigarh, India
| | - Susheen Dutt
- Department of Otorhinolaryngology, Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | - Svati Bansal
- Department of Ophthalmology, Medanta - The Medicity, Gurugram, Haryana, India
| | - Swati Amulbhai Ravani
- M and J Western Regional Institute of Ophthalmology, Byramjee Jeejeebhoy Medical College, Ahmedabad, Gujarat, India
| | - Sweta Lohiya
- Department of Otorhinolaryngology, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Syed Wajahat Ali Rizvi
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Tanmay Gokhale
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Tatyarao P Lahane
- Department of Ophthalmology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, Maharashtra, India
| | | | - Triveni Grover
- Department of Ophthalmology, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Trupti Bhesaniya
- Department of Ophthalmology, Government Medical College, Surat, Gujarat, India
| | - Urmil Chawla
- Regional Institute of Ophthalmology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Usha Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vaishali L Une
- Department of Ophthalmology, Shree Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - Varsha Nandedkar
- Department of Ophthalmology, Government Medical College, Aurangabad, Maharashtra, India
| | | | - Vidya Eswaran
- Department of Ophthalmology, Bowring and Lady Curzon Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Vidya Nair Chaudhary
- Department of Ophthalmology, Aakash Healthcare Super-Specialty Hospital, New Delhi, India
| | | | - Vipin Dehane
- Department of Oral and Maxillofacial Surgery, Kingsway Hospital, Nagpur, Maharashtra, India
| | - Vivek M Sahasrabudhe
- Department of Ophthalmology, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
| | | | - Yashaswini Tupkary
- Department of Medicine, Dr. Hedgewar Rugnalaya, Aurangabad, Maharashtra, India
| | - Yogita Phadke
- Department of Ophthalmology, Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, Maharashtra, India
| | | |
Collapse
|
25
|
Martel A, Lassalle S, Picard-Gauci A, Gastaud L, Montaudie H, Bertolotto C, Nahon-Esteve S, Poissonnet G, Hofman P, Baillif S. New Targeted Therapies and Immunotherapies for Locally Advanced Periocular Malignant Tumours: Towards a New 'Eye-Sparing' Paradigm? Cancers (Basel) 2021; 13:2822. [PMID: 34198863 PMCID: PMC8201354 DOI: 10.3390/cancers13112822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 12/26/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Arnaud Martel
- Department of Ophthalmology, University Hospital of Nice, Cote d’Azur University, 06000 Nice, France; (S.N.-E.); (S.B.)
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Cote d’Azur University, 06000 Nice, France; (S.L.); (P.H.)
| | - Sandra Lassalle
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Cote d’Azur University, 06000 Nice, France; (S.L.); (P.H.)
- Biobank BB-0033-00025, FHU OncoAge, IRCAN, Laboratory of Clinical and Experimental Pathology, University Hospital of Nice, 06000 Nice, France
| | - Alexandra Picard-Gauci
- Department of Dermatology, Archet 2 Hospital, 151 Route de Saint-Antoine, 06200 Nice, France; (A.P.-G.); (H.M.)
| | - Lauris Gastaud
- Department of Oncology, Antoine Lacassagne Cancer Centre, 06000 Nice, France;
| | - Henri Montaudie
- Department of Dermatology, Archet 2 Hospital, 151 Route de Saint-Antoine, 06200 Nice, France; (A.P.-G.); (H.M.)
| | - Corine Bertolotto
- Department of Biology and Pathologies of Melanocytes, Team1, Equipe Labellisée Ligue 2020 and Equipe Labellisée ARC 2019, Centre Méditerranéen de Médecine Moléculaire, Inserm, 06200 Nice, France;
| | - Sacha Nahon-Esteve
- Department of Ophthalmology, University Hospital of Nice, Cote d’Azur University, 06000 Nice, France; (S.N.-E.); (S.B.)
| | - Gilles Poissonnet
- Cervicofacial Surgery Department, Antoine Lacassagne Cancer Centre, 06000 Nice, France;
| | - Paul Hofman
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Cote d’Azur University, 06000 Nice, France; (S.L.); (P.H.)
- Biobank BB-0033-00025, FHU OncoAge, IRCAN, Laboratory of Clinical and Experimental Pathology, University Hospital of Nice, 06000 Nice, France
| | - Stephanie Baillif
- Department of Ophthalmology, University Hospital of Nice, Cote d’Azur University, 06000 Nice, France; (S.N.-E.); (S.B.)
| |
Collapse
|
26
|
Traylor JI, Christiano LD, Esmaeli B, Hanasono MM, Yu P, Suki D, Zhang W, Raza SM, Hanna EY, DeMonte F. Outcomes of orbital exenteration for craniofacial lesions. Cancer 2021; 127:2465-2475. [PMID: 33799313 DOI: 10.1002/cncr.33526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022]
Abstract
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).
Collapse
Affiliation(s)
- Jeffrey I Traylor
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lana D Christiano
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bita Esmaeli
- Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew M Hanasono
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peirong Yu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dima Suki
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wen Zhang
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Shaan M Raza
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
27
|
Reed L, Lyon K, Benardete EA. Successful Endovascular Treatment of Delayed Spontaneous Intracranial Internal Carotid Artery Blowout Following Orbital Exenteration and Radiation. Cureus 2020; 12:e11535. [PMID: 33354479 PMCID: PMC7746314 DOI: 10.7759/cureus.11535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Most head and neck cancers require aggressive surgical resection followed by external beam radiation therapy. The carotid artery can be injured by surgery or radiation resulting in a delayed “blowout.” A patient who had undergone orbital exenteration for a lacrimal adenoid cystic carcinoma (ACC) followed by external beam radiation presented 16 years later with arterial bleeding from the orbit caused by “blowout” of the cavernous internal carotid artery (ICA). We review the literature on carotid blowout syndrome (CBS) and treatment. The patient was emergently transferred to a hybrid operating room and underwent a balloon occlusion test (BOT) and endovascular sacrifice of the ICA with no neurological deficits postoperatively. Emergent endovascular embolization is an effective treatment for an intracranial ICA blowout in this first reported case of a blowout through the orbit. Elevated radiation dose and lack of tissue coverage may put the cavernous ICA at risk for this delayed complication.
Collapse
Affiliation(s)
- Laura Reed
- Neurosurgery, Baylor, Scott & White Healthcare, Temple, USA
| | | | | |
Collapse
|
28
|
Abstract
This article reviews the most common locations and natural history of sinonasal carcinomas. It also reviews surgical indications and current evidence regarding adjuvant and neoadjuvant therapies. In the past, orbital clearance was generally done for ethmoid and maxillary cancers, even without a marked neoplastic infiltration; however, such indications have changed in the recent years due to advances in our understanding of the disease, as well as new chemotherapeutic and radiotherapy protocols. Surgical resection of tumors close to the orbit exhibits the challenging task of balancing treatment goals and patient's desires.
Collapse
Affiliation(s)
- Camilo Reyes
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Augusta University, Augusta, Georgia, United States
| | - Mihir Patel
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute at Emory University, Emory University, Atlanta, Geogia, United States
| | - C Arturo Solares
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute at Emory University, Emory University, Atlanta, Geogia, United States
| |
Collapse
|
29
|
Bejinariu CG, Dragosloveanu CDM, Marinescu SA. Complex reconstruction of the orbitofrontal regions using three regional flaps after orbital exenteration for the treatment of basal cell carcinoma. Rom J Ophthalmol 2020; 64:57-61. [PMID: 32292859 PMCID: PMC7141915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective. The current paper presents an interesting case of facial reconstruction after the excision of a giant basal cell carcinoma located in the orbitofrontal region. Methods. Performing the excision while securing the appropriate oncologic safety margin has determined the appearance of a soft tissue defect that required a complex reconstruction using three regional flaps: frontal, temporal fascial and temporal muscle flaps. Results. After the excision and reconstruction in a single surgical stage, the postoperative result was favorable, the 12 months assessment showing that the patient was satisfied with the aesthetic aspect. Conclusion. Including the orbital exenterations in the excisional treatment of giant neoplasms located in the facial region requires a complex reconstructive plan. The surgical team has to consider the relief of the anatomical structures that are targeted, as well as the necessity of achieving satisfactory aesthetic results while ensuring oncological radicality.
Collapse
Affiliation(s)
- Cătălin Gheorghe Bejinariu
- Department of Plastic and Reconstructive Surgery, “Bagdasar-Arseni”
Clinical Emergency Hospital, Bucharest, Romania
| | | | - Silviu Adrian Marinescu
- Department of Plastic and Reconstructive Surgery, “Bagdasar-Arseni”
Clinical Emergency Hospital, Bucharest, Romania
| |
Collapse
|
30
|
Mukoyama N, Nishio N, Kimura H, Kishi S, Tokura T, Kimura H, Hiramatsu M, Maruo T, Tsuzuki H, Fujii M, Iwami K, Takanari K, Kamei Y, Ozaki N, Sone M, Fujimoto Y. Prospective Evaluation of Health-Related Quality of Life in Patients Undergoing Anterolateral Craniofacial Resection with Orbital Exenteration. J Neurol Surg B Skull Base 2019; 81:585-593. [PMID: 33134027 DOI: 10.1055/s-0039-1694010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/28/2019] [Indexed: 12/25/2022] Open
Abstract
Objective This study was aimed to evaluate health-related quality of life in patients undergoing anterolateral craniofacial resection (AL-CFR) with orbital exenteration (OE) for malignant skull base tumors and to investigate the effects of early psychiatric intervention. Design Present study is a prospective, observational study. Setting The study took place at the hospital department. Participants Twenty-six consecutive patients were selected who underwent AL-CFR with OE at our hospital between 2005 and 2015. Main Outcome Measures Health-related quality of life was assessed preoperatively and 3, 6, 12, and 24 months after surgery using the Hospital Anxiety and Depression Scale (HADS) and medical outcomes study 8-items Short Form health survey (SF-8). In all cases, psychiatric intervention was organized by the consultation liaison psychiatry team preoperatively and postoperatively. Results Ten (38.0%) of the 26 patients died and 16 (62.0%) were alive and disease-free at the end of the study. The 3-year overall and disease-free survival rates were 64.9% and 53.3%, respectively. Twenty-one patients (80.8%) developed psychiatric complications after surgery and needed treatment with psychotropic medication. Before surgery, 28% of patients had HADS scores ≥8 for anxiety and 20% had scores ≥8 for depression. Seven of the eight items in the SF-8 were significantly lower than those for the general Japanese population. However, scores for all the SF-8 items gradually improved during postoperative follow-up, reaching approximately 50 points, which is the national standard value, at 2 years after surgery. Conclusions Craniofacial resection with OE was feasible and well tolerated in patients with malignant skull base tumors who received early psychiatric intervention to decrease the considerable psychological impact of this procedure.
Collapse
Affiliation(s)
- Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Otolaryngology, Stanford University, Stanford, California, United States
| | - Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinichi Kishi
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuya Tokura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Maruo
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidenori Tsuzuki
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masazumi Fujii
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Kenichiro Iwami
- Department of Neurosurgery, Aichi Medical University, Aichi, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
Turri-Zanoni M, Lambertoni A, Margherini S, Giovannardi M, Ferrari M, Rampinelli V, Schreiber A, Cherubino M, Antognoni P, Locatelli D, Battaglia P, Castelnuovo P, Nicolai P. Multidisciplinary treatment algorithm for the management of sinonasal cancers with orbital invasion: A retrospective study. Head Neck 2019; 41:2777-2788. [PMID: 30932253 DOI: 10.1002/hed.25759] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/19/2019] [Accepted: 03/18/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sinonasal cancers frequently involve the orbit with resulting controversies on whether to remove or preserve the orbital contents. METHODS Retrospective review of patients with primary sinonasal cancer involving the orbit, treated according to a multidisciplinary protocol tailored to tumor histology and extent of orbital invasion in two tertiary care referral centers over a 20-year period. RESULTS The oncological and functional outcomes of 163 patients were analyzed. The degree of orbital involvement significantly affected both overall (P < .0001) and disease-free (P < .0001) survival. Orbital apex invasion was an independent negative prognostic factor (5-year overall survival, 14.6% ± 7.5%), with dismal prognosis regardless of the treatment adopted. An appropriate use of induction chemotherapy and endoscopic-assisted surgery allowed for orbital preservation in 76.6% of cases; 96% of patients treated using an orbit-sparing approach maintained a functional eye after treatment. CONCLUSION The multimodal treatment algorithm herein proposed was able to maximize orbital preservation rates with acceptable oncological and functional outcomes.
Collapse
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
| | - Alessia Lambertoni
- Division of Otorhinolaryngology, 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
| | - Marta Giovannardi
- Unit of Biostatistics, Department of Statistics, Monzino Hospital, Milan, Italy
| | - Marco Ferrari
- Division of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Division of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Division of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Brescia, 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
| | - Paolo Antognoni
- Division of Radiation Oncology, 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
| | - 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
| | - 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
| | - Piero Nicolai
- Division of Otorhinolaryngology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| |
Collapse
|
34
|
Lucke-Wold B, Mendez G, Cua D, Akins P, Gillham H, Ciporen J. Combined Endoscopic Transorbital and Endonasal Repair of High Flow Orbital Apex/Middle Fossa Cerebrospinal Fluid Leak with a Nasoseptal Flap. J Neuroinflamm Neurodegener Dis 2018; 2:100005. [PMID: 29676403 PMCID: PMC5903292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND IMPORTANCE High flow orbital apex or middle fossa cerebrospinal fluid (CSF) leaks can be life threatening and complex to repair. These leaks associated with large dural defects are most commonly repaired with an open temporalis muscle patch or free flaps, but these flaps do not always stop the leak. CLINICAL PRESENTATION A 65-year-old patient presented two years after orbital exenteration and radiation for squamous cell carcinoma. He developed multi-organism meningitis and pneumocephalus secondary to a large high-flow orbital apex/middle fossa CSF leak. To repair the leak, a combined endoscopic transorbital/endonasal approach with pedicled nasospetal flap and dermis fat graft was used. We describe the unique endoscopic technique that was used to treat the life threatening high flow orbital apex/middle fossa CSF leak. The technique allowed the use of the transposed pedicled flap, which is an alternative to the free flap in controlling CSF leak. Cisternogram post-operatively and clinical exam confirmed resolution of CSF leak. Although a critically ill patient at admission with a modified Rankin scale (MRS) of 5, he was discharged home on continued IV antibiotic therapy with a MRS of 3. Endoscopic evaluation at three months after treatment showed the effectiveness of the flap and he continued to improve clinically. CONCLUSION This is the first case to describe a combined endoscopic transorbital and endonasal repair of high flow orbital apex/middle fossa CSF leak with a pedicled nasoseptal flap. These techniques can be utilized during initial reconstruction after orbital exenteration or as a salvage flap.
Collapse
Affiliation(s)
- Brandon Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, USA
| | - Gustavo Mendez
- Department of Radiology, Oregon Health and Science University, USA
| | - David Cua
- Department of Neurosurgery, The Permanente Medical Group, USA
| | - Paul Akins
- Department of Neurosurgery, The Permanente Medical Group, USA
| | - Haley Gillham
- Department of Neurosurgery, Oregon Health and Science University, USA
| | - Jeremy Ciporen
- Department of Neurosurgery, Oregon Health and Science University, USA
| |
Collapse
|
35
|
Ghabrial R, Ananda A, van Hal SJ, Thompson EO, Larsen SR, Heydon P, Gupta R, Cherepanoff S, Rodriguez M, Halmagyi GM. Invasive Fungal Sinusitis Presenting as Acute Posterior Ischemic Optic Neuropathy. Neuroophthalmology 2017; 42:209-214. [PMID: 30042790 DOI: 10.1080/01658107.2017.1392581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022] Open
Abstract
Invasive fungal sinusitis causes painful orbital apex syndrome with ophthalmoplegia and visual loss; the mechanism is unclear. We report an immunocompromised patient with invasive fungal sinusitis in whom the visual loss was due to posterior ischaemic optic neuropathy, shown on diffusion-weighted MRI, presumably from fungal invasion of small meningeal-based arteries at the orbital apex. After intensive antifungal drugs, orbital exenteration and immune reconstitution, the patient survived, but we were uncertain if the exenteration helped. We suggest that evidence of acute posterior ischaemic optic neuropathy should be a contra-indication to the need for orbital exenteration in invasive fungal sinusitis.
Collapse
Affiliation(s)
- Rafat Ghabrial
- Ophthalmology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Arjun Ananda
- Otorhinolaryngology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sebastiaan J van Hal
- Microbiology and Infectious Diseases Department, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Peter Heydon
- Ophthalmology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ruta Gupta
- Anatomical Pathology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Michael Rodriguez
- Anatomical Pathology Department, St Vincent's Hospital, Sydney, Australia
| | | |
Collapse
|
36
|
Jørgensen M, Heegaard S. A review of nasal, paranasal, and skull base tumors invading the orbit. Surv Ophthalmol 2018; 63:389-405. [PMID: 28739401 DOI: 10.1016/j.survophthal.2017.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022]
Abstract
Tumors that invade the orbit are uncommon. The majority are meningiomas arising from the sphenoid ridge (66%). Others are bone and cartilage tumors arising from the surrounding bones of the orbit, pituitary adenomas, and epithelial tumors arising from the paranasal sinuses and nasal cavity. Meningiomas occur more often in women, whereas epithelial tumors have a predilection for men. Meningiomas and epithelial tumors typically present in the sixth decade of life, whereas bone tumors tend to affect individuals in their third decade of life. Patients often present with a combination of ophthalmological and otorhinolaryngological symptoms, including proptosis, pain, decreased visual acuity, restrictions in motility of the eye, epistaxis, and nasal obstruction. Sarcomas and benign bone and cartilage tumors arise from surrounding structures, whereas carcinomas usually arise from the paranasal sinuses. Surgery is the mainstay of treatment. Depending on the aggressiveness and histology of the tumor, surgery may be combined with radiation and chemotherapy. The prognosis is generally poor, but varies depending on histology and cell origin, size of the tumor, and degree of invasion. Meningiomas and benign bone tumors have the best prognoses. Sinonasal undifferentiated carcinomas, small-cell neuroendocrine carcinomas, osteosarcomas, and rhabdomyosarcomas have poorer prognoses.
Collapse
|
37
|
Tassone P, Gill KS, Hsu D, Nyquist G, Krein H, Bilyk JR, Murchison AP, Evans JJ, Heffelfinger RN, Curry JM. Naso- or Orbitocutaneous Fistulas after Free Flap Reconstruction of Orbital Exenteration Defects: Retrospective Study, Systematic Review, and Meta-Analysis. J Neurol Surg B Skull Base 2017; 78:337-345. [PMID: 28725521 DOI: 10.1055/s-0037-1600135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/10/2017] [Indexed: 10/19/2022] Open
Abstract
Objective Naso- or orbitocutaneous fistula (NOF) is a challenging complication of orbital exenteration, and it often requires surgical repair. We sought to identify the incidence and risk factors for NOF after orbital exenteration. Study Design Retrospective chart review, systematic review, meta-analysis. Setting Tertiary care center. Participants Patients undergoing free flap reconstruction following orbital exenteration. Records were reviewed for clinicopathologic data, operative details, and outcomes. Main Outcome Measures Univariate analysis was used to assess risk factors for incidence of postoperative NOF. PubMed and Cochrane databases were searched for published reports on NOF after orbital exenteration. Rates of fistula and odds ratios for predictive factors were compared in a meta-analysis. Results Total 7 of 77 patients (9.1%) developed NOF; fistula formation was associated with ethmoid sinus involvement ( p < 0.05) and minor wound break down ( p < 0.05). On meta-analysis, pooled rates of fistula formation were 5.8% for free flap patients and 12.5% for patients receiving no reconstruction. Conclusion Immediate postoperative wound complications and medial orbital wall resection increased the risk for NOF. On review and meta-analysis, reconstruction of orbital exenteration defects decreased the risk for fistula formation, but published series did not demonstrate a significant decrease in risk with free flaps compared with other methods of reconstruction.
Collapse
Affiliation(s)
- Patrick Tassone
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Philadelphia, Pennsylvania, United States
| | - Kurren S Gill
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Philadelphia, Pennsylvania, United States
| | - David Hsu
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Philadelphia, Pennsylvania, United States
| | - Gurston Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Philadelphia, Pennsylvania, United States
| | - Howard Krein
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Philadelphia, Pennsylvania, United States
| | - Jurij R Bilyk
- Skullbase Division, Neuro-ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
| | - Anna P Murchison
- Skullbase Division, Neuro-ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
| | - James J Evans
- Department of Neurological Surgery, Division of Neuro-Oncologic Neurosurgery, Thomas Jefferson University Philadelphia, Pennsylvania, United States
| | - Ryan N Heffelfinger
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Philadelphia, Pennsylvania, United States
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Philadelphia, Pennsylvania, United States
| |
Collapse
|
38
|
Muscatello L, Fortunato S, Seccia V, Marchetti M, Lenzi R. The implications of orbital invasion in sinonasal tract malignancies. Orbit 2016; 35:278-284. [PMID: 27541943 DOI: 10.1080/01676830.2016.1193532] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 05/20/2016] [Indexed: 06/06/2023]
Abstract
In recent decades, the management of sinonasal tumors abutting the orbit has been widely discussed. A real guideline has yet to be proposed, as prospective randomized studies on this topic are very difficult to organize, given the relative rarity of this pathology, the wide spectrum of histologic patterns, and the different clinical behavior of tumors. Nevertheless, in recent years, a better assessment of tumor extension has been obtained thanks to the refinement of preoperative imaging tools and, therefore, more conservative approaches could be adopted, with no worsening of the oncological outcomes and, at the same time, with more attention given to the post-surgical quality of life. Currently, tumors that extend to the bony orbital walls with or without focal infiltration of the periorbit are amenable to orbital preservation. On the other hand, infiltration of extraocular muscles and neurovascular structures are an indication to orbital exenteration. The ideal surgical treatment in cases of limited involvement of orbital fat still remains a matter of debate. We report and discuss the recent English literature on this interesting topic.
Collapse
Affiliation(s)
- Luca Muscatello
- a Division of Otorhinolaryngology , " S.s. Giacomo e Cristoforo" General Hospital , Massa , Italy
| | - Susanna Fortunato
- b Department of Neuroscience, Unit of Otolaryngology, Audiology and Phoniatrics , University of Pisa , Italy
| | - Veronica Seccia
- c 1st Otorhinolaryngology Unit , Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Manuela Marchetti
- a Division of Otorhinolaryngology , " S.s. Giacomo e Cristoforo" General Hospital , Massa , Italy
| | - Riccardo Lenzi
- a Division of Otorhinolaryngology , " S.s. Giacomo e Cristoforo" General Hospital , Massa , Italy
| |
Collapse
|
39
|
Abstract
The authors report their experience with orbital exenteration surgery at one academic institution over a 10-year period and review the literature. This retrospective cohort study monitored outcomes of all patients who underwent orbital exenteration surgery at Massachusetts Eye and Ear Infirmary between January 2003 and January 2013. Patients with no follow-up data or survival data were excluded from the study. The main outcome measures were surgical complications, disease status of surgical margins, need for adjuvant treatment, local recurrence, metastases and survival. 23 patients with malignancy and 2 with mucormycosis met inclusion criteria for the study. Surgical procedures included non-lid sparing total exenteration (44%), lid-sparing total exenteration (32%), non-lid sparing partial exenteration (8%) and lid-sparing partial exenteration (16%). 44% underwent additional extra-orbital procedures. Survival rates were 72% at 1 year, 48% at 3 years, and 37% at 5 years. Of patients with malignancies, 48% had clear margins after exenteration. There was no statistically significant difference in survival between patients with negative surgical margins compared to positive margins (p = 0.12). Mortality was highest in patients with melanoma (85.7%) and lowest in patients with non-squamous cell lid malignancies (0%). Our study suggests that the type of disease has a much greater impact on the survival of patients undergoing exenteration surgery than the type of exenteration surgery or the disease status of surgical margins. Patients with non-squamous cell lid malignancies and localized orbital disease have the best prognosis for tumor eradication from this radical and highly disfiguring surgery.
Collapse
Affiliation(s)
- Sonali T Nagendran
- a Department of Ophthalmology , Frimley Park Hospital , Surrey , United Kingdom
| | - N Grace Lee
- b Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
| | - Aaron Fay
- b Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
| | - Daniel R Lefebvre
- b Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
| | - Francis C Sutula
- b Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
| | - Suzanne K Freitag
- b Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
| |
Collapse
|
40
|
Abstract
Squamous cell carcinoma of the eyelid is the second most common malignant neoplasm of the eye with the incidence of 0.09 and 2.42 cases/100 000 people. Orbital invasion is a rare complication but, if recognized early, can be treated effectively with exenteration. Although with advancements in technology such as computer-aided design and computer-aided manufacturing, material science, and retentive methods like implants, orbital prosthesis with stock ocular prosthesis made of methyl methacrylate retained by anatomic undercuts is quiet effective and should not be overlooked and forgotten. This clinical report describes prosthetic rehabilitation of two male patients with polymethyl methacrylate resin orbital prosthesis after orbital exenteration, for squamous cell carcinoma of the upper eyelid. The orbital prosthesis was sufficiently retained by hard and soft tissue undercuts without any complications. The patients using the prosthesis are quite satisfied with the cosmetic results and felt comfortable attending the social events.
Collapse
Affiliation(s)
- Sumeet Jain
- Department of Prosthodontics, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - Parul Jain
- Consultant Novel Dental N Implant Clinic, Indore, Madhya Pradesh, India
| |
Collapse
|
41
|
Cooper J, Dharmasena A, Malik R, Cook A. Reliability and Effectiveness of the Manchester Orbital Exenteration Wound Assessment Tool: Inter-Observer Agreement. Orbit 2015; 34:127-31. [PMID: 25879862 DOI: 10.3109/01676830.2015.1014506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To evaluate the inter-observer agreement of the Manchester Orbital Exenteration Wound Assessment Tool (MOEWAT), a tool designed to facilitate grading of healing in exenterated sockets, scores from clinical photographs of exenterated sockets. METHODS Existing MOEWAT system was modified to allow grading of clinical photographs. Photographs of 36 different patients at different stages of healing following exenteration were identified. Scores for two masked observers, who independently graded the photographs were compared. The inter-observer agreement of scores was assessed using a Bland-Altman plot, with the average agreement and 95% confidence interval around the mean computed. RESULTS The average age of the 36 patients was 66 ± 29 years. Photographs were taken 32 ± 16 months after exenteration. Across all photographs, the averages score given by the first observer (4.3 ± 2.2) and second observer (3.4 ± 1.5) were similar (t = -1.9; p = 0.07). From the Bland-Altman plot, the mean difference in score (0.8 ± 1.8) was close to zero, with 95% confidence limits for agreement are indicated by the dashed lines and spanning from -2.6 to 4.3. CONCLUSION MOEWAT can be successfully used to stage wound healing in exenterated sockets, with good inter-observer agreement.
Collapse
Affiliation(s)
- John Cooper
- Manchester Royal Eye Hospital, Manchester , United Kingdom and
| | | | | | | |
Collapse
|
42
|
Sugawara T, Aoyagi M, Ogishima T, Kawano Y, Tamaki M, Yano T, Tsunoda A, Ohno K, Maehara T, Kishimoto S. Extended orbital exenteration for sinonasal malignancy with orbital apex extension: surgical technique and clinical analysis. J Neurosurg 2015; 123:52-8. [PMID: 25816080 DOI: 10.3171/2014.9.jns141256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The majority of sinonasal malignancies present with advanced disease, and cure rates are generally poor. Surgical extirpation remains the mainstay of treatment. In cases of sinonasal malignancy with orbital apex extension, gross-total tumor resection requires orbital exenteration and bony skull base resection around the orbital apex to provide sufficient margins. In this retrospective study, the authors describe their surgical strategy in and technique for orbital exenteration with orbital apex resection in patients at Tokyo Medical and Dental University who had sinonasal malignancy with orbital apex extension. They also analyzed the clinical features of and the results in these patients. METHODS Between February 2001 and August 2012 at the authors' institution, sinonasal malignancy with orbital apex extension was treated using craniofacial tumor resection with orbital exenteration including skull base bone around the orbital apex. The authors describe this technique and analyze the surgical indications, extent of resection, primary tumor location, outcome, pathological findings, and neoadjuvant and adjuvant therapies of the patients who underwent the technique. RESULTS The patients consisted of 12 men and 3 women with a mean age of 47.7 years (range 14-79 years). The longest postoperative follow-up was 9.5 years, and the shortest was 0.67 year (mean 3.0 years). Tumor originated at the ethmoid sinus in 6 patients (40%), maxillary sinus in 5 (33%), nasal cavity in 2 (13%), and orbital cavity and maxillary bone in 1 patient each (7%). Histological analysis of tumor specimens revealed squamous cell carcinoma in 9 patients (60%), rhabdomyosarcoma in 2 (13%), and small cell carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, and Ewing sarcoma in 1 patient each (7%). Two patients experienced recurrences at 1 and 5 months after treatment; these patients died at 5 and 10 months after surgery, respectively. Estimated 5-year recurrence-free survival (RFS) was 86.7%, and estimated 5-year overall survival (OS) was 86.2%; there was no perioperative mortality. None of the patients had new neurological deficits as a result of the surgery, but 5 patients suffered infectious complications from the graft transplanted into the cavity after resection. There were no other perioperative complications. CONCLUSIONS These authors are the first to describe a technique for extended orbital exenteration with orbital apex skull base resection. The technique provided sufficient margins for gross-total resection of the sinonasal malignancy with orbital apex extension. The estimated 5-year OS and RFS rates were high, and the perioperative complication rate was acceptably low, demonstrating the safety and efficacy of this technique.
Collapse
Affiliation(s)
| | | | | | | | - Masashi Tamaki
- Department of Neurosurgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Tomoyuki Yano
- Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo
| | | | | | | | - Seiji Kishimoto
- Head and Neck Surgery.,Department of Head and Neck Surgery, Kameda Medical Center, Chiba; and
| |
Collapse
|
43
|
Motomura H, Iguchi H, Hatano T, Kobayashi R, Sakahara D, Fujii N, Mineo M. Dynamic eye socket reconstruction after extensive resection of midfacial malignancies: preliminary results using temporalis transfer. Acta Otolaryngol 2014; 134:1205-10. [PMID: 25315921 DOI: 10.3109/00016489.2014.940555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The functional and esthetic results of reconstructive surgery after extended total maxillectomy or extended orbital exenteration greatly depend on the quality of the orbital reconstruction. We developed dynamic eye socket reconstruction using temporalis transfer to achieve good orbital reconstruction, and examined the usefulness of our technique. Five patients (three men and two women, aged 44-72 years) who underwent extensive resection of midfacial malignancies were treated with dynamic eye socket reconstruction using temporalis transfer. In most cases, eye socket reconstruction was performed approximately 1 year after the initial surgery, and temporalis transfer was used after maturation of the eye socket. The follow-up period ranged from 16 to 120 months (average 63.8 months). Movement of the upper and lower eyelids was achieved in all cases, and definite creases at the lateral canthus were observed in two patients. A good shape in the reconstructed medial and lateral canthal areas was maintained in all patients. Our reconstruction technique is extremely effective in creating natural creases ('crow's feet') at the lateral canthus during smiling, enabling movement of the upper and lower eyelids, and maintaining a sharp palpebral morphology.
Collapse
Affiliation(s)
- Hisashi Motomura
- Department of Plastic and Reconstructive Surgery, Osaka City University Graduate School of Medicine , Osaka , Japan
| | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Maxillary reconstruction is still an evolving art when compared to the reconstruction of the mandible. The defects of maxilla apart from affecting the functions of the speech, swallowing and mastication also cause cosmetic disfigurement. Rehabilitation of the form and function in patients with maxillary defects is either by using an obturator prosthesis or by a surgical reconstruction. Literature is abundant with a variety of reconstructive methods. The classification systems are also varied, with no universal acceptance of any one of them. The oncologic safety of these procedures is still debated, and conclusive evidence in this regard has not emerged yet. Management of the orbit is also not yet addressed properly. Tissue engineering, that has been hyped to be one of the possible solutions for this vexing reconstructive problem, has not come out with reliable and reproducible results so far. This review article discusses the rationale and oncological safety of the reconstructing the maxillary defects, critically analyzes the classification systems, offers the different reconstructive methods and touches upon the controversies in this subject. The management of the retained and exenterated orbit associated with maxillectomy is reviewed. The surgical morbidity, complications and the recent advances in this field are also looked into. An algorithm, based on our experience, is presented.
Collapse
Affiliation(s)
- Subramania Iyer
- Department of Plastic, Reconstructive and Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Plastic, Reconstructive and Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| |
Collapse
|
45
|
Abstract
BACKGROUND Orbital exenteration (OE) is a disfiguring procedure which typically involves removal of the entire contents of the orbit including the periorbita, appendages, eyelids and, sometimes, a varying amount of surrounding skin and bone. It results in devastating functional, aesthetic and psychological losses. DESIGN This study reports an experience of OE in a Teaching Hospital in Accra Ghana. METHOD The records of all patients who underwent OE between November 2005 and October 2009 were reviewed retrospectively. These were cases seen at the orbit and oculoplastic clinic of the eye unit. RESULTS A total of 25 patients underwent OE. Nineteen (76%) of these were for invasive orbital squamous cell carcinomas and six (24%) were for other cases. Only one patient had OE for a benign condition (orbital haemangioma). Four patients had lid sparing procedures. One of these was for a patient with extensive ocular surface squamous cell carcinoma. Five patients had recurrent tumours. Among those patients with squamous cell carcinoma, seven had previous procedures, sometimes multiple before reporting to our clinic. CONCLUSION Orbital exenterations in developing countries are mostly for neglected periorbital and ocular surface malignancies. Educating patients to seek medical attention as soon as they notice a persistent conjunctival growth could prevent this.
Collapse
Affiliation(s)
- E Ackuaku-Dogbe
- Department of Surgery, Eye Unit, University of Ghana Medical School, P. O. Box 4236, Accra, Ghana.
| |
Collapse
|
46
|
Croce A, Moretti A, D'Agostino L, Zingariello P. Orbital exenteration in elderly patients: personal experience. Acta Otorhinolaryngol Ital 2008; 28:193-199. [PMID: 18939708 PMCID: PMC2644992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 04/24/2008] [Indexed: 05/26/2023]
Abstract
Orbital exenteration is a disfiguring procedure which typically involves removal of the entire contents of the orbit including the periorbita, appendages, eyelids and, sometimes, a varying amount of surrounding skin. This operation is reserved for the treatment of potentially life-threatening malignancies arising from the orbit, paranasal sinuses or periocular skin. The marked increase in the average life span and resulting greater incidence of invasive malignant skin tumours of the face, typical of old age, is the reason for the increased rate of exenterations in elderly patients. The purpose of this report is to describe personal experience regarding 8 operations of orbital exenteration carried out on elderly patients, 6 males and 2 females, age range 66-85 years (mean 75), who came to our observation, from January 2002 to December 2007, on account of cancer (7 cases: 4 basal cell carcinomas; 1 squamous cell carcinoma; 1 fibrosarcoma; 1 melanoma) or infectious inflammatory disease (1 case of rhinocerebral mucormycosis) and were treated with type III orbital exenteration (2 cases) and type IV orbital exenteration (6 cases according to Meyer and Zaoli's classification). The methods used to reconstruct the eye-socket consisted of a full-thickness skin graft in 5 cases, pedicled myocutaneous flaps in 2 cases--a latissimus dorsi muscle flap alone, in one patient, and combined with a pectoralis major muscle flap in another - and a combined lateral-based frontal fasciocutaneous pedicled flap and full-thickness skin graft in the oldest patient. Regarding survival and the local clinical situation, 3 of the 4 patients with basal cell carcinomas are alive and disease-free after 6 years, 2 years and 20 months, respectively, while the oldest patient died of the disease after 10 months. The subject who underwent surgery for squamous cell carcinoma is alive and disease-free after 2 years. The patients with melanoma, fibrosarcoma and mucormycosis died. Although there are various options available for reconstruction, full-thickness skin graft or a pedicled muscolocutaneous flap provide the simplest solution in the elderly population with significant co-morbidities. The final outcome is, in our experience, comparable to that of more complex flap reconstruction, obtaining very good final results with minimal donor site morbility and a reduced operation time.
Collapse
Affiliation(s)
- A Croce
- Otorhinolarygology Unit, Department of Surgical Sciences, Clinical and Experimental, G. D'Annunzio University of Chieti and Pescara, Italy.
| | | | | | | |
Collapse
|