Skip to main content
Log in

Modified types of orbital exenteration, survival, and reconstruction

  • Oculoplastics and Orbit
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

Data are available on request.

References

  1. Mohr C, Esser J (1997) Orbital exenteration: surgical and reconstructive strategies. Graefes Arch Clin Exp Ophthalmol 235:288–295

    Article  CAS  Google Scholar 

  2. Levin PS, Dutton JJ (1991) A 20-year series of orbital exenteration. Am J Ophthalmol 112:496–501

    Article  CAS  Google Scholar 

  3. 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

  4. 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

    Article  PubMed  PubMed Central  Google Scholar 

  5. 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

    Article  CAS  PubMed  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Croce A, Moretti A, D’Agostino L, Zingariello P (2008) Orbital exenteration in elderly patients: personal experience. Acta Otorhinolaryngol Ital 28:193–199

    CAS  PubMed  PubMed Central  Google Scholar 

  10. 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

  11. 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

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. Goldberg RA, Kim JW, Shorr N (2003) Orbital exenteration: results of an individualized approach. Ophthal Plast Reconstr Surg 19:229–236

    Article  Google Scholar 

  14. 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

    Article  CAS  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. Catalano PJ, Laidlaw D, Sen C (2001) Globe sparing orbital exenteration. Otolaryngol Head Neck Surg 125:379–384

    Article  CAS  Google Scholar 

  17. 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

    Article  Google Scholar 

  18. Gunalp I, Gunduz K, Duruk K (1995) Orbital exenteration: a review of 429 cases. Int Ophthalmol 19:177–184

    Article  Google Scholar 

  19. Simons JN, Robinson DW, Masters FW (1966) Malignant tumors of the orbit and periorbital structures treated by exenteration. Plast Reconstr Surg 37:100–104

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Sven Holger Baum.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (No. 18-8406-BO) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-020-04812-7

Keywords

Navigation