SURGICAL OUTCOME OF LID SPARING ORBITAL EXENTERATION WITH PRESERVATION OF THE ORBITAL PERIOSTEUM FOR SOCKET AND LID RECONSTRUCTION
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 71
Abstract
BACKGROUND Orbital exenteration is a life-saving desperate procedure to remove the whole eyeball along with muscle, fascia, fat, etc. It is commonly performed in case of intraocular malignancy, which invade extraocular orbital content. It may be primary from eyeball itself or secondary from the other source, e.g. breast, lungs, bone. After lid sparing orbital exenteration, forehead rotational flap was made for lid reconstruction and it achieves acceptable functional cosmetic appearance. The aim of the study was to evaluate the surgical and cosmetic outcome of lid sparing orbital exenteration with preservation of orbital periosteum and recurrence of the malignancy, effectiveness of socket and lid reconstruction after forehead rotational flap, split thickness and dermis fat graft. MATERIALS AND METHODS This was a descriptive case study of thirty eyes and patients over a period of four years. In this study, mean age of the patient was 67.93. Male-to-female ratio was 2:3. All the patients had biopsy proven ocular malignancy with spreading tendency. Peroperative all quadrant frozen section biopsy, map biopsy and optic nerve stump biopsy were performed in all the cases. Lid sparing orbital exenteration with the preservation of orbital periosteum was performed in all the cases. Simultaneously, forehead rotational flap for lid reconstruction and split thickness skin graft and dermis fat graft was made for lid and socket reconstruction. Patient was followed up for six months to two years. RESULTS Total number of patients was thirty, of which males were 12 and females were 18. Lid sparing orbital exenteration with preservation of orbital periosteum was performed in all the cases. Simultaneously, forehead rotational flap was made for lid reconstruction. All the patients were followed up for six months to two years. No such recurrence of the disease was seen. All the patients had moderate-to-good cosmetic outcome with adequate prosthetic fitting. Peroperative all quadrant frozen sections, map biopsy and optic nerve stump biopsy were performed in all the cases. Most of the cases were categorised as orbital, ocular and adnexal malignancy with squamous cell carcinoma (40%) and basal cell carcinoma (23%) being the most common. Mesothelial tumours 6% and Adenoid cystic carcinoma 1 (3%) were the least in this study. Complications occurred in some of the cases as infection and partial graft rejection. All the thirty patients had satisfactory surgical, cosmetic and functional outcome. Preservation of the orbital periosteum is much effective for split thickness skin graft and dermis fat graft to accept the host orbital bed. Simultaneously, successful lid reconstruction was performed from temporal arterial base, forehead rotational flap for prosthetic fitting and better cosmetic appearance. CONCLUSION Lid sparing orbital exenteration with preservation of orbital periosteum is effective for socket and lid reconstruction. Split thickness skin graft and dermis fat graft were effective for socket reconstruction. Satisfactory cosmetic and functional outcome of the orbit and lid was achieved after successful forehead rotational flap operation. Early diagnosis and treatment avoid the destructive surgery and preserve orbital periosteum. No such recurrence of malignancy was seen in six months to two-year followup period. Overall, patient’s psychological and social rehabilitation was much more improved.
Authors and Affiliations
Salil Kumar Mandal, Tamojit Chatterjee, James Christian Fleming
Keywords
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- EP ID EP265529
- DOI 10.14260/Jemds/2017/1102
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