Surgery for orbital tumors. Part II: transorbital approaches

Orbital tumors can be excised or biopsy samples obtained via transorbital approaches, especially those located in the anterior two thirds of the orbit. The indications and various surgical steps will be reviewed for the anterior, the anteromedial, and the lateral approaches. Some of these approaches can be combined or extended to accommodate large or deep-seated tumors.

Experience with eyelid-sparing orbital exenteration: the 2000 Tullos O. Coston Lecture

PURPOSE

To provide data on types of lesions that require orbital exenteration and discuss our experience with exenteration, emphasizing the eyelid-sparing technique.

METHODS

The records were reviewed on all patients who underwent orbital exenteration by the senior author and his colleagues. The underlying disease, method of exenteration, healing times, complications, cosmetic outcome, local tumor control, and patient survival were analyzed.

RESULTS

Of 56 orbital exenterations, 47 were done by eyelid-sparing technique and 9 by eyelid-sacrificing technique. The 9 tumors of eyelid origin that required exenteration included basal cell carcinoma (4), sebaceous gland carcinoma (3), squamous cell carcinoma (1), and melanoma (1). Four of the eyelid lesions were managed by the eyelid-sparing technique and 5 by the eyelid-sacrificing method. The 24 tumors of conjunctival origin included melanoma (20) and squamous cell carcinoma (4). The eyelid-sparing method was used in 22 of the 24 cases. The 10 primary orbital lesions included melanoma (3), malignant lacrimal gland tumor (3), a rhabdoid tumor, meningioma, Wegener's granulomatosis, and aspergillosis. The eyelid-sparing method was used in 8 of the 10 cases. Among intraocular tumors were uveal melanomas (10) and retinoblastoma (1). The eyelid sparing method was used in all 11. With the eyelid-sparing technique, the mean time from exenteration to wound healing and readiness for a prosthesis was 4 weeks (median, 2 weeks; range, 2 to 24 weeks). With the eyelid-sacrificing technique, the mean time was 68 weeks (median, 34 weeks; range, 2 to 340 weeks). Complications were few and cosmetic results were satisfactory. Local tumor control with exenteration was achieved in 53 of 56 cases, but metastasis occurred in 11 of 20 cases of conjunctival melanoma (55%) and in 6 of 10 patients with uveal melanoma (60%). Metastasis has developed in none of the 3 patients with malignant epithelial tumors of lacrimal gland origin.

CONCLUSIONS

Orbital exenteration is an appropriate procedure for orbital involvement by unresectable malignant tumors of the eyelids, conjunctiva, intraocular structures, and orbit. In most of these cases, including about half of tumors originating in the eyelids, an eyelid-sparing exenteration can be used to achieve more rapid healing.

Orbital exenteration for invasive skin tumours

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

Postmortem orbital findings in shaken baby syndrome

PURPOSE

To compare postmortem orbital findings in pediatric accidental head injury to Shaken Baby Syndrome (SBS).

DESIGN

Retrospective study.

METHODS

SETTING

Institutional.

STUDY POPULATION

Thirty-six patients underwent postmortem modified exenteration with sectioning of the orbital contents; 18 victims of SBS and 18 cases of fatal accidental head trauma.

OBSERVATION PROCEDURE

In all cases of children who died from accidental head trauma, the orbital tissues were separated to expose the optic nerve sheath. Patients with gross evidence of hemorrhage within the sheath were included. All cases of SBS were included. After accidental head injury, exenteration was performed only if optic nerve sheath hemorrhage was suspected on gross examination. All children younger than 18 years old with head injury as primary cause of death were included. SBS is defined as having at least two of the following: (1) typical abnormal findings on neuroimaging, (2) typical skeletal injury, (3) retinal hemorrhages, (4) history of abusive shaking with or without blunt head trauma, or (5) an inadequate history to explain the observed injuries.

MAIN OUTCOME MEASURE

Presence or absence of orbital hemorrhage.

RESULTS

Orbital tissue injury is more common in SBS than accidental head trauma without orbital fracture. In addition, optic nerve sheath and optic nerve intradural hemorrhage are also significantly more common in SBS (P < .0001).

CONCLUSIONS

Our study reports new evidence of injury to orbital tissues in SBS and supports the concept that these finding are due to unique acceleration-deceleration forces of this type of abusive head injury.

Orbital exenteration: results of an individualized approach

PURPOSE

The authors report and evaluate their experience with an individualized approach to orbital exenteration.

METHODS

Retrospective chart review was performed on a consecutive series of 25 orbital exenteration patients at a tertiary care center. The cases were classified into two groups for the retrospective analysis: Total exenteration procedures involved the removal of the entire orbital contents including the periorbita (13 cases), and subtotal procedures preserved at least a quadrant of the orbit or the orbital tissues posterior to the globe (12 cases).

RESULTS

The total exenteration group had a lower rate of clear surgical margins and a higher rate of systemic metastasis, whereas patients in the subtotal exenteration group had fewer surgical complications and better functional and aesthetic results.

CONCLUSIONS

The surgical planning for orbital exenteration should take into account the location, extent, and biological behavior of the orbital disease process and the reconstructive and prosthetic options for the exenterated socket. When an individualized approach to orbital exenteration is used, subtotal procedures can offer improved functional and aesthetic results while still maximizing the chances for a surgical cure.

Surgical Management of Locally Advanced Adenoid Cystic Carcinoma of the Lacrimal Gland

PURPOSE

To review our experience with multidisciplinary surgical management of locally advanced adenoid cystic carcinoma of the lacrimal gland.

METHODS

We present a case series of 7 patients with lacrimal gland adenoid cystic carcinoma treated at our institution between June 2001 and October 2003. Clinical records, histologic sections, and radiographic images were reviewed.

RESULTS

The study included 3 men and 4 women (mean age at diagnosis, 44 years). All 7 patients underwent an orbital exenteration with bone removal. Five patients had an orbitectomy through a craniotomy approach and 2 patients had an exenteration through a fronto-orbito-zygomatic approach, all with removal of the bone of the superior and lateral wall. Six patients underwent reconstruction of the socket through the use of a vascularized flap. The surgical approach involved a neurosurgeon, an oculoplastic or head and neck surgeon, and a plastic surgeon. Six patients received postoperative radiation therapy. One patient with a recurrent tumor had already received radiation therapy, which precluded additional radiation therapy after surgical resection. The radiation field included the orbit and the skull base because all patients had evidence of perineural invasion. As of this writing, there have been no local recurrences. Five patients had development of distant metastases and died of disease, at follow-up times from 12 to 32 months after surgery. Two patients are alive without evidence of disease, both at 24 months' follow-up.

CONCLUSIONS

Orbitectomy with bone removal may be indicated for achieving local and regional control in advanced cases of adenoid cystic carcinoma of the lacrimal gland. This surgery does not decrease the risk of distant metastasis. The cases in our series highlight the locally invasive and metastatic behavior of this cancer.

Invasive sino-orbital aspergillosis: surgical decisions and dilemmas

Invasive aspergillosis, one of the common paranasal sinus fungal infections, often secondarily involves the orbit. We report six such cases with orbital extension, all occurring in apparently immunocompetent hosts, to specifically address the difficult diagnostic and therapeutic issues involved. Limited biopsy procedures were often inconclusive, necessitating wide surgical excision to establish the histopathological diagnosis. Conservative orbital debridement proved adequate for cases with disease limited to the infero-medial compartment of the orbit, but resulted in residual progressive disease in the two of the four cases with retro-orbital and apical extension. Orbital exenteration in this latter group, however, proved successful in controlling disease. The present report emphasizes the importance of near-complete extirpation and adjuvant chemotherapy in ensuring a favourable outcome in invasive Aspergillus infections. Orbital exenteration appears justified for posterior orbital disease, regardless of the functional status of the eye, but is inappropriate for anterior orbital disease.

Orbital exenteration: surgical and reconstructive strategies

BACKGROUND

Radical exenteration procedures, which include the removal of orbital content and eyelids, result in serious functional limitations, especially with respect to eating and speaking. Therefore we have recently changed our surgical concept.

METHODS

Seventy-seven patients underwent orbital exenteration during the 20-year period from 1974 to 1995 at the Department of Maxillofacial Surgery, Essen University. The simultaneous removal of periorbital bone was performed in 45 of these cases.

RESULTS

The 1-year survival rate was 89%, the 5-year rate was 63% and the 10-year rate was 48%. The surgical approach, the amount of resected orbital tissue and the reconstructive procedure have been adapted to the individual needs, depending on the location and extent of the tumor. Subsequently, the surgical morbidity has decreased.

DISCUSSION

Detailed consideration of all clinical and histological findings is essential before surgery, in order to prevent a higher rate of recurrence following these modified operations.

Evisceration with scleral modification

PURPOSE

To describe an evisceration technique that combines scleral modification with optic nerve release for coverage of any sized orbital implant.

METHODS

The medical records of 70 patients who underwent the described evisceration procedure were reviewed.

RESULTS

The average implant was 20 mm in diameter, with 50 patients (71%) receiving a solid polymethylmethacrylate sphere. Fifty-eight patients (83%) had a history of at least one previous ocular surgery, and 12 patients (17%) had phthisical eyes preoperatively with moderate to severe scleral cicatrization. Postoperatively, there were two cases of new or worsened ptosis, no cases of worsened motility, and no cases of implant extrusion.

CONCLUSION

Evisceration with scleral modification is a simple and effective procedure that allows placement of any size orbital implant. Surgical results are excellent with few complications.

Massive Congenital Orbital Teratoma

Orbital teratomas are rare embryonic tumors composed of a wide diversity of tissues derived from the three germinal layers. The presenting features include, a healthy newborn with extreme unilateral proptosis; marked stretching of the eyelids over a tense, fluctuating mass, with elongation of the palpebral fissure; enlargement of the bony orbit (two to three times normal size) with subsequent nasal and malar deformities; and transillumination of all or part of the orbital mass. Commonly the eye is normally developed but often vision is not preserved either due to exposure or secondary optic atrophy. The objective in the management of orbital teratoma is to save the eye to encourage orbitofacial development, maintain cosmesis and retain some vision. We report a case of massive congenital orbital teratoma successfully removed by an eyelid-sparing exenteration technique.

Orbital exenteration: a 10-year experience of a general oncology hospital

BACKGROUND

The aim of this study is to review the 10-year experience with orbital exenteration, determining the indications, clinical features of patients and the factors that cause the need for exenteration.

METHODS

The records of patients that underwent exenteration between 1997 and 2007 were reviewed retrospectively. The age, sex, the location of tumour, the duration of symptoms, histopathological diagnosis, and previous recurrences were noted.

RESULTS

Orbital exenteration was performed on 68 patients. Bone resection in 6 and sinusectomy in 13 patients was combined with exenteration. The major indication was secondary orbital tumours accounting for 95.6% of the series and the eyelid and conjunctival tumours were the most frequent. Seven different types of histopathology were encountered: squamous cell carcinoma (31 cases), basal cell carcinoma (26 cases), malignant melanoma (5 cases), sebaceous cell carcinoma (2 cases), rhabdomyosarcoma (2 cases), mucoepidermoid carcinoma (1 case) and adenoid cystic carcinoma (1 case). The rate of previous recurrence was 85.7% in eyelid tumours and 42.1% in the conjunctival tumours.

CONCLUSIONS

Large proportion of the patients that underwent exenteration had a history of previous unsuccessful treatment and a long duration of disease. Because exenteration of the orbit is a disfiguring procedure, the incidence must be reduced by early presentation, prompt treatment, and adequate observation to preserve the eye.

Use of a caudal auricular axial pattern flap in three cats and one dog following orbital exenteration

Orbital exenteration accompanied by wide eyelid excision in the cat and dog may leave a defect that cannot be closed in a primary fashion. This report describes the use of a caudal auricular axial pattern flap to effect closure following orbital exenteration in three cats and one dog. The most common complication was distal flap necrosis, which necessitated a second surgery in two patients.

Surgical management of tumors involving the orbit

IMPORTANCE

Surgical treatment of orbital tumors is a complex task that requires thorough preparation and precise planning. Since a large variety of tumors of different origins, anatomical extents, and histologic subtypes affect the globe, no "1-size-fits-all" approach can be offered.

OBJECTIVE

To describe an integrative approach for the optimal surgical management of patients with orbital tumors based on a review of the literature and on our own experience at a high-volume cancer center.

EVIDENCE REVIEW

Peer-reviewed English-language literature and a single-center cohort of patients undergoing orbital exenteration with eye sparing, reconstruction, and preservation of orbital function.

FINDINGS

Surgical treatment of orbital tumors is a complex task that requires thorough preparation and precise planning that would be aided by an algorithm.

CONCLUSIONS AND RELEVANCE

We offer an algorithm that summarizes our approach toward the 2 main decision points of orbital surgery: extent of resection and method of reconstruction.

Globe sparing orbital exenteration

OBJECTIVE

Orbital exenteration has long been the oncologic standard for malignant craniofacial lesions that invade the periorbita/orbit from adjacent locations. Although oncologically sound, this radical surgical procedure is cosmetically disfiguring for all patients. Most of the reconstructive options available are complex, requiring further surgery and/or expense. We herein introduce an alternative surgical technique for radical orbital surgery that spares the globe, thereby allowing an early, aesthetic appearance at a nominal cost.

STUDY DESIGN AND SETTING

Twenty consecutive patients requiring an oncologic orbital exenteration and meeting the indications for the new procedure underwent surgery at a tertiary care medical center. Follow-up ranged from 1 to 6 years.

RESULTS

Only 1 patient recurred in the orbit due to an error in patient selection. There was no surgical morbidity resulting from the globe-sparing technique itself.

CONCLUSION

Globe-sparing orbital exenteration is a one-step, oncologically sound, aesthetically superior, low-cost alternative for those patients requiring radical orbital surgery and reconstruction.

Pancreatic metastases from ocular malignant melanoma: the use of endoscopic ultrasound-guided fine-needle aspiration to establish a definitive cytologic diagnosis: a case report

BACKGROUND

When encountering solid pancreatic lesions, nonpancreatic primary metastases are rare and differentiating a metastasis from a primary neoplastic lesion is challenging. The clinical presentation and radiologic features can be similar and the possibility of a pancreatic metastasis should be considered when the patient refers to a history of a different primary cancer. Endoscopic ultrasound offers a key anatomical advantage in accessing the pancreas and endoscopic ultrasound-guided fine-needle aspiration has become the gold standard method for diagnosing pancreatic lesions.

CASE PRESENTATION

A 58-year-old white Hispanic woman with a history of uveal malignant melanoma, presented with abdominal pain and jaundice. On admission, laboratory tests were performed (her total bilirubin was 6.37 mg/dL with a direct fraction of 5.30 mg/dL). Cross-sectional, abdominal computed tomography with contrast, showed a low-attenuating lesion localized in the pancreatic head (measuring 4 × 3 cm) and a thinner section of the distal bile duct suspicious for compression. Our patient was scheduled for an endoscopic ultrasound-guided fine-needle aspiration to establish a diagnosis. Endoscopic ultrasound showed a solid, hypoechoic, well-defined lesion with regular contours (measuring 3.17 × 2.61 cm), localized between the head and neck of the pancreas. Endoscopic ultrasound-guided fine-needle aspiration was performed with a 22G needle and cytology confirmed the diagnosis of metastatic melanoma. Our patient subsequently underwent right orbital exenteration, followed by duodenopancreatectomy without complications. At the moment our patient is receiving adjuvant chemotherapy at an outside oncology clinic.

CONCLUSIONS

To the best of our knowledge, this is a very rare presentation of an ocular malignant melanoma with an isolated pancreatic metastasis causing symptomatic biliary obstruction. Endoscopic ultrasound-guided fine-needle aspiration has proven to be the best method to diagnose solid pancreatic lesions. In this particular case, cytology was essential in confirming the diagnosis and guiding the most adequate therapy, which was a pancreatic resection, ocular exenteration of the melanoma, followed by adjuvant chemotherapy.

A case of congenital orbital malignant rhabdoid tumor: systemic metastasis following exenteration

A newborn girl presented with massive proptosis of the right eye. Physical and radiologic examination disclosed that the primary orbital mass was confined to the site. A diagnosis of malignant rhabdoid tumor was made by histopathologic examination of an incisional biopsy specimen. Exenteration was performed, and the resection margins were free from tumor cells. However, distant metastasis developed in the liver 1 month after surgery. Despite chemotherapy, the patient died 2 months later due to tumor invasion into the central nervous system, which was confirmed by autopsy. To the best of our knowledge, this is the first case of congenital orbital malignant rhabdoid tumor showing systemic metastasis after exenteration, which suggests the need for aggressive systemic treatment rather than exenteration, even in a case of locally confined tumor.

Complete Mobilization of the Cheek Zone for Orbit Exenteration

Patients with malignant orbital tumors often undergo eyeball excision, orbital tissues and lids, which results in severe deformities. Our experience concerns the use of a skin fascial flap of the cheek zone, the V-Y design, in 10 patients after ocular malignant tumor resection. Seven patients had basal cell carcinomas of the lower lids with invasion of the ocular tissues. The complete tumor resection was controlled by frozen-section biopsy in all patients. The results were evaluated from an oncologic, functional, and aesthetic point of view. We noticed 2 recurrences in a minimum follow up of 2 years. The functional and aesthetic results were quite satisfactory and no serious complications were noticed in our series. The primary advantage of this interesting flap is the dominant vasculature derived from arteria transversa faciei, arteria facialis, and arteria infraorbitalis that secure good vascular contribution. It should be regarded as very useful for surface coverage problems at the orbit because it performs in a one-stage procedure with minimum morbility and good functional result.

Éviscération modifiée pour implant orbitaire biocolonisable : la technique des « quatre carrés »

INTRODUCTION

The introduction of a porous, biocolonizable, orbital implant is difficult after a classic evisceration. We have developed a modification of the method that provides better results.

MATERIAL AND METHODS

Four scleral squares pediculized on the right oculomotor muscles were cut. They were sutured two-by-two over the anterior part of the implant.

RESULTS

Fifteen patients were operated. There were no complications during a mean follow-up of 12.4 months.

DISCUSSION

The soft anterior tissues were protected by the two vascularized scleral layers. The diameter of the implant was 18 mm for three patients, 20 mm for eight patients, and 22 mm for four patients. Operating time was much shorter than with enucleation and covering of the implant with autologous sclera.

CONCLUSION

Evisceration with the four-square technique is a safe and quick method, which can be used for most patients, except those with an intraocular neoplasia.

Orbital reconstruction following sino-nasal mucormycosis

We discuss the reconstruction of an orbit destroyed by an invasive fungal infection. Sino-nasal mucormycosis is usually associated with a poor prognosis, and occurs almost exclusively in immunocompromised patients. Serial imaging leading to repeated radical debridement, along with intravenous amphotericin, helped the patient to recover from this serious disease. A well-vascularised galeal frontalis-pericranial flap from the mid-forehead region was used to reconstruct the orbital defect.

Supratrochlear artery island paramedian forehead flap for reconstructing the exenterated patient

Orbital exenteration may be needed for surgical extirpation of advanced squamous or basal carcinoma of the eye or ocular adnexa. Many surgeons prefer to allow the exenterated socket granulate by secondary intention. This leads to morbidity and can be very disturbing for the patient. Moreover, it delays the delivery of adjunctive radiation often required in these individuals. We suggest a 1-stage operation that can be undertaken at the time of exenteration or as a delayed procedure to reconstruct the orbit and ensure rapid wound healing and patient rehabilitation. There is minimal donor site morbidity. A total of 5 exenterated orbits have been reconstructed by a new technique utilizing islanded median forehead flap based upon ipsilateral supratrochlear vessels. The donor site could be closed primarily in all patients. The healing was uneventful; the median hospital stay was 3 days. Although there is inevitable scarring of the forehead, this improves considerably over a period of time and does not appear to cause undue aesthetic concerns among our patients. Thus an islandised ipsilateral paramedian forehead flap based upon supratrochlear vessels is another option to close an exenteration defect.

Treatment of Metastatic Eyelid Carcinoma

PURPOSE

The aim of this study was to report management and outcomes in patients affected by eyelids carcinomas involving regional lymph nodes.

METHODS

We have retrospectively analyzed the data of patients affected by eyelids carcinoma with nodal involvement. The clinical records of 10 patients with malignant eyelid carcinoma and regional nodal metastasis treated between September 2011 and March 2015 have been analyzed.

RESULTS

The study included 5 women and 5 men (median age 54,5 years; range 37-80 years). The most common tumor was the squamous cell carcinoma (4 cases) followed by sebaceous carcinoma (2 cases): 1 case of epidermoid carcinoma, 1 case of malignant melanoma, 1 case of Merkel carcinoma, and 1 case of basal cell carcinoma. All patients were treated by surgical resection; in 2 cases, orbital exenteration was required. The treatment of regional nodal metastasis consisted of parotidectomy and radical neck dissection followed by radiation therapy. None of the patients developed local recurrence. Three patients died: one, affected by Merkel cell carcinoma, died after 2 months because of metastatic dissemination to the lung; another one, affected by epidermoid carcinoma involving the orbit, died because of liver metastasis; the third one, affected by malignant melanoma, died because of other causes. The follow-up time ranged from 9 to 36 months (median 19.3 months).

CONCLUSIONS

Patients affected by advanced malignant eyelid carcinoma need to be strictly controlled because metastasis can develop at least 5 years after surgical treatment. Therapy may include a combination of local surgery, neck dissection, and radiation.

[Primary soft tissue coverage and specific after-care of endosseous implants in pre-irradiated orbits]

After orbital exenteration and high- dose irradiation (60 Gy on average), 17 endosseous implants were placed periorbitally in 5 patients. No hyperbaric oxygen therapy was performed. All implants were primarily covered with regional or free flaps. After second-stage surgery and aesthetic rehabilitation with an external maxillofacial prosthesis, the pocket depth and implant stability (periotest) were checked, an occipitonasomental radiograph was taken and the soft tissue assessed in short recall intervals. When the implant was uncovered, osseointegration was stable. Within a follow-up period of 35 months, no fixation had failed. In two patients, peri-implant inflammation (microbiologically confirmed Staphylococcus aureus) occurred, which was clinically only determined by soft tissue oedema and rubor. The results demonstrate primary soft tissue covering as essential for non-irritating implant osseointegration in the irradiated orbita. In extraoral implants the clinical estimation of the peri-implant soft tissue, including a microbiological examination, is required for early detection of peri-implant inflammation in order to avoid secondary implant failure. In contrast, periotest and pocket depth are not relevant in recognizing an ensuing peri-implant inflammation.

Modified procedure of anterior orbital exenteration enables eye socket reconstruction: A retrospective cohort study

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.

[Primary benign orbital tumors in experience of the Department of Otolaryngology Jagiellonian University]

BACKGROUND

The important question in primary eye socket tumors surgery is total surgery and saving the patient's sight.

THE AIM OF THE STUDY

It was assessment of the data of primary non malignant tumor therapy in Cracovian Department of Otolaryngology.

MATERIAL AND METHODS

145 patients (79 male and 66 female), aged 7 months-84 years, were treated in Otolaryngological Department Jagiellonian University in years 1991-2001. In 118 cases primary benign orbital tumors were removed, in remaining patients tumors were malignant. In 89 patients lateral orbitotomy by Kronlein was performed and in other cases different types of orbitotomy were used. 5 years otolaryngological and ophtalmological catamnnesis wascomplete.

RESULTS

In all patients eyeball was preserved, even in 6 with optic nerve glioma. Reccurent tumors were observed in 2 cases, diplopia in 15 patients and sight's lost in 8 (in 6 with optic nerve glioma).

CONCLUSIONS

In the majority of patients with radical oncological surgery it is possible to preserve eyesight.