Abstract
Purpose
This study aims to analyse the various modifications of orbital exenteration.
Methods
Patients undergoing orbital exenteration from March 1978 to October 2019 were included in this retrospective study. The patients were evaluated on the basis of the indication, type of exenteration, reconstruction technique, overall survival (OS), and disease-free survival (DFS).
Results
In total, 300 patients were enrolled in this study. As many as 24 patients had lid and conjunctiva sparing anterior exenteration, 16 had lid sparing anterior exenteration, 83 had anterior exenteration, 14 had lid and conjunctiva sparing total exenteration, seven had lid sparing total exenteration, 44 had total exenteration, one had lid and conjunctiva sparing extended exenteration, 23 had lid sparing extended exenteration, and 88 had extended exenteration. As many as 39 patients had a primary wound closure. Six patients underwent reconstruction with a split-thickness skin graft, 177 patients with a local or regional flap, and 40 patients with a microvascular flap. A total of 38 patients did not undergo reconstruction. The mean follow-up was 40 months (range 6–216 months). The OS rate was 82.2% after 1 year, 58.5% after 5 years, and 49% after 10 years for all patients with malignant tumours. The DFS rate was 67.7% after 1 year, 45.6% after 5 years, and 31.7% after 10 years.
Conclusion
Individual types of orbital exenteration allow patient-adapted therapies. The preservation of uninvolved orbital tissue facilitates orbital reconstruction. The type of exenteration did not have any influence on overall survival.
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Data availability
Data are available on request.
References
Mohr C, Esser J (1997) Orbital exenteration: surgical and reconstructive strategies. Graefes Arch Clin Exp Ophthalmol 235:288–295
Levin PS, Dutton JJ (1991) A 20-year series of orbital exenteration. Am J Ophthalmol 112:496–501
Kiratli H, Koc I (2017) Orbital exenteration: institutional review of evolving trends in indications and rehabilitation techniques. Orbit:1–8. https://doi.org/10.1080/01676830.2017.1383466
Snaith J, Burns K, Kok J, Chen S, Cheung NW (2016) A case of rhino-orbital mucormycosis in diabetes with haematogenous cerebral spread. Med Mycol Case Rep 13:22–24. https://doi.org/10.1016/j.mmcr.2016.10.002
Klein M, Menneking H, Spring A, Rose M (2005) Analysis of quality of life in patients with a facial prosthesis. Mund Kiefer Gesichtschir 9:205–213. https://doi.org/10.1007/s10006-005-0614-8
Kuiper JJ, Zimmerman MB, Pagedar NA, Carter KD, Allen RC, Shriver EM (2016) Perception of patient appearance following various methods of reconstruction after orbital exenteration. Orbit 35:187–192. https://doi.org/10.1080/01676830.2016.1176207
Ali MJ, Pujari A, Dave TV, Kaliki S, Naik MN (2016) Clinicopathological profile of orbital exenteration: 14 years of experience from a tertiary eye care center in South India. Int Ophthalmol 36:253–258. https://doi.org/10.1007/s10792-015-0111-5
Hoffman GR, Jefferson ND, Reid CB, Eisenberg RL (2016) Orbital exenteration to manage infiltrative sinonasal, orbital adnexal, and cutaneous malignancies provides acceptable survival outcomes: an institutional review, literature review, and meta-analysis. J Oral Maxillofac Surg 74:631–643. https://doi.org/10.1016/j.joms.2015.09.019
Croce A, Moretti A, D’Agostino L, Zingariello P (2008) Orbital exenteration in elderly patients: personal experience. Acta Otorhinolaryngol Ital 28:193–199
Zhang Z, Ho S, Yin V, Varas G, Rajak S, Dolman PJ, McNab A, Heathcote JG, Valenzuela A (2017) Multicentred international review of orbital exenteration and reconstruction in oculoplastic and orbit practice. Br J Ophthalmol. https://doi.org/10.1136/bjophthalmol-2017-310681
Bhattacharjee K, Bhattacharjee H, Kuri G, Singh M, Barman MJ (2017) Single-stage socket reconstruction with vascularised temporalis muscle flap following total orbital exenteration: description of 3 surgical approaches. Orbit 36:69–77. https://doi.org/10.1080/01676830.2017.1279655
Baum SH, Schmeling C, Pfortner R, Mohr C (2018) Autologous dermis-fat grafts as primary and secondary orbital transplants before rehabilitation with artificial eyes. J Craniomaxillofac Surg 46:90–97. https://doi.org/10.1016/j.jcms.2017.10.016
Goldberg RA, Kim JW, Shorr N (2003) Orbital exenteration: results of an individualized approach. Ophthal Plast Reconstr Surg 19:229–236
Hanasono MM, Lee JC, Yang JS, Skoracki RJ, Reece GP, Esmaeli B (2009) An algorithmic approach to reconstructive surgery and prosthetic rehabilitation after orbital exenteration. Plast Reconstr Surg 123:98–105. https://doi.org/10.1097/PRS.0b013e3181904b95
Nagendran ST, Lee NG, Fay A, Lefebvre DR, Sutula FC, Freitag SK (2016) Orbital exenteration: the 10-year Massachusetts eye and ear infirmary experience. Orbit 35:199–206. https://doi.org/10.1080/01676830.2016.1176210
Catalano PJ, Laidlaw D, Sen C (2001) Globe sparing orbital exenteration. Otolaryngol Head Neck Surg 125:379–384
Emesz M, Oberascher G, Moser G, Maria Arlt EM, Maria Krall EM, Rasp M, Bachernegg A (2014) Exenteratio Orbitae–chirurgische und rekonstruktive Strategien. Spektrum Augenheilkd 28:10–16. https://doi.org/10.1007/s00717-013-0203-4
Gunalp I, Gunduz K, Duruk K (1995) Orbital exenteration: a review of 429 cases. Int Ophthalmol 19:177–184
Simons JN, Robinson DW, Masters FW (1966) Malignant tumors of the orbit and periorbital structures treated by exenteration. Plast Reconstr Surg 37:100–104
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Sven Baum: conceptualisation, methodology, validation, investigation, formal analysis, writing. Michael Oeverhaus: conceptualisation, resources. Franziska Saxe: conceptualisation, resources. Christopher Mohr: conceptualisation, supervision, writing—review and editing.
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Baum, S.H., Oeverhaus, M., Saxe, F. et al. Modified types of orbital exenteration, survival, and reconstruction. Graefes Arch Clin Exp Ophthalmol 258, 2305–2312 (2020). https://doi.org/10.1007/s00417-020-04812-7
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DOI: https://doi.org/10.1007/s00417-020-04812-7