Abstract
• 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.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Albrektsson T, Branemark PI, Jacobsson M, Tjellström A (1987) Present clinical applications of osteointegrated percutaneous implants. Plast Reconstr Surg 79:721–730
Bakamjian V, Souther S (1975) Use of temporal muscle flap for reconstruction after orbito-maxillary resections for cancer. Plast Reconstr Surg 56:171–177
Baker SR (1984) Closure of large orbito-maxillary defects with free latissimus dorsi myocutaneous flaps. Head Neck Surg 6:828–835
Deleted in production
Bartley GB, Garrity JA, Waller RR, Henderson JW, Ilstrup DM (1989) Orbital exenteration at the Mayo Clinic. Ophthalmology 96:468–473
Bonavolonta G (1992) Frontalis muscle transfer in the reconstruction of the exenterated orbit. Adv Ophthalmic Plast Reconstr Surg 9: 239–242
Brent B, Upton J, Acland R, Shaw W, Finseth F, Rogers C, Pearl R, Hentz V (1985) Experience with the temporoparietal fascial free flap. Plast Reconstr Surg 76: 177–188
Bridger GP, Baldwin M, Gonski A (1986) Craniofacial resection for paranasal sinus cancer with free flap repair. Aust N Z J Surg 56: 843–847
Cheesman A, Quiney R, Wright J (1989) Craniofacial resections for orbital tumors. Ann R Coll Surg England 71:333–337
Chicarilli ZN, Davey LM (1987) Rectus abdominis myocutaneous free flap reconstruction following a cranio-orbital-maxillary resection for neurofibrosarcoma. Plast Reconstr Surg 80:726–731
Donahue PJ, Liston SL, Falconer DP, Manlove JC (1989) Reconstruction of orbital exenteration cavities: the use of the latissimus dorsi myocutaneous free flap. Arch Ophthalmol 107:1681–1683
Dortzbach RK, Hawkes MJ (1981) Midline forehead flap in reconstructive procedures of the eyelids and exenterated socket. Ophthalmic Surg 12:257–268
Fox SA (1970) Socket repairs. In: Fox SA (ed) Ophthalmic plastic surgery, 4th edn. Grune and Stratton, New York, pp 449–462
Frezotti R, Nuti A (1982) Repair after orbital exenteration. Acta Neurochir 60:119–124
Gola R, Waller PY, Chossegros C, Semeria E (1991) Reparation des cavites d'exenteration orbitaire elargie. Rev Stomatol Chir Maxillofac 92:8–13
Graamans K, Slootweg PJ (1989) Orbital exenteration in surgery of malignant neoplasms of the paranasal sinuses: the value of preoperative computed tomography. Arch Otolaryngol Head Neck Surg 115:977–980
Guyuron B, Labandter H, Berlin J (1984) Fasciocutaneous flap, secondary axial pattern flap and microvascular free flap in socket reconstruction. Ophthalmology 91:94–101
Henderson JW (1987) Adenoid cystic carcinoma of the lacrimal gland: is there a cure? Trans Am Ophthalmol Soc 85:312–319
Höltje W, Schwipper V, Winkler K (1988) Konservative Exenteratio orbitae bei kindlichen Orbitasarkomen. In: Schwenzer N, Pfeiffer G (eds) Fortschritte der Kiefer-und Gesichtschirurgie, vol 33., Thieme, Stuttgart, pp 43–46
Iliff CE (1957) Tumors of the orbit. Trans Am Ophthalmol Soc 55:505–541
Jackson IT, Adham M, Marsh W (1986) Use of the galeal frontalis myofascial flap in craniofacial surgery. Plast Reconstr Surg 77:905–910
Kersten RC, Tse DT, Anderson RL, Blodi FC (1985) The role of orbital exenteration in choroidal melanoma with extrascleral extension. Ophthalmology 92:436–443
Levin PS, Ellis DS, Stewart WB, Toth BA (1991) Orbital exenteration: the reconstructive ladder. Ophthalmic Plast Reconstr Surg 7:84–92
Levin PS, Dutton JJ (1991) A 20-year series of orbital exenteration. Am J Ophthalmol 112:496–501
Lindberg JV, Orcutt JC, van Dyk HJL (1985) Orbital surgery. In: Duane TJ (ed) Clinical ophthalmology. Harper and Row, Hagerstown, pp 38–43
Mann W, Rareshide E, Schildwaechter A (1989) Nasennebenhöhlentumoren mit orbitaler Beteiligung. Laryngorhinootologie 68:667–670
Mercer DM (1988) The cervicofacial flap. Br J Plast Surg 41:470–474
Meyer R, Kesselring UK (1974) Rekonstruktionen im Orbitagebiet. In: Bohmert H (ed) Plastische Chirurgie des Kopf- und Halsbereiches. Thieme, Stuttgart, pp 49–54
Mohr C, Havers W (1994) Die Aufgaben des Gesichtschirurgen im Behandlungskonzept embryonaler Rhabdomyosarkome. Dtsch Z Mund Kiefer Gesichtschir 18:20–24
Naquin HA (1954) Exenteration of the orbit. Arch Ophthalmol 51:850–862
Nerad JA, Carter KD, Lavelle WE, Fyler A, Branemark PI (1991) The osseointegration technique for the rehabilitation of the exenterated orbit. Arch Ophthalmol 109:1032–1038
Ohtsuka H (1988) Eye socket and eyelid reconstruction using the combined island frontal flap and retroauricular island flap: a preliminary report. Ann Plast Surg 20:244–248
Origitano TC, Al-Mefty O, Leonetti JP, Izquierdo R (1992) En bloc resection of an ethmoid carcinoma involving the orbit and medial wall of the cavernous sinus. Neurosurgery 31:1126–1131
Perry C, Levine PA, Williamson BR, Cantrell RW (1988) Preservation of the eye in paranasal sinus cancer surgery. Arch Otolaryngol Head Neck Surg 114:632–634
Polito E, Leccisotti A (1993) Epithelial malignancies of the lacrimal gland: survival rates after extensive and conservative therapy. Ann Ophthalmol 25:422–426
Putterman AM (1986) Orbital exenteration with spontancous granulation. Arch Ophthalmol 104:139–140
Rathbun JE, Beard C, Quickert MH (1971) Evaluation of 48 cases of orbital exenteration. Am J Ophthalmol 72:191–199
Reese AB (1958) Exenteration of the orbit with transplantation of the temporalis muscle. Am J Ophthalmol 45:386–390
Rini FJ, Jakobiec FA, Hornblass A, Beckerman BL, Anderson RL (1987) The treatment of advanced choroidal melanoma with massive orbital extension. Am J Ophthalmol 104:634–640
Roosen HM (1987) Treatment of malignant cranio-orbital tumors. Clin Plast Surg 14: 137–142
Rose GE, Wright JE (1994) Exenteration for benign orbital disease. Br J Ophthalmol 78: 14–18
Savage RC (1983) Orbital exenteration and reconstruction for massive basal cell and squamous cell carcinoma of cutaneous origin. Ann Plast Surg 10:458–466
Schettler D, Mohr C, Schmidt U (1988) Zur Therapie des orbitalen Rhabdomyosarkoms. In: Schwenzer N, Pfeiffer G (eds) Fortschritte der Kiefer-und Gesichtschirurgie, vol 33., Thieme, Stuttgart, pp 41–43
Shields JA, Shields CL, Suvarnamani C, Tantisira M, Shah P (1991) Orbital exenteration with eyelid sparing: indications, technique, and results. Ophthalmic Surg 22:292–297
Shore JW, Burks WR, Leone C, McCord CD (1986) Dermis fat graft for orbital reconstruction after subtotal exenteration. Am J Ophthalmol 102:228–236
Stern SJ, Goepfert H, Clayman G, Byers R, Wolf P (1993) Orbital preservation in maxillectomy. Otolaryngol Head Neck Surg 109:111–115
Tahara S, Susuki T (1989) Eye socket reconstruction with free radial forearm flap. Ann Plast Surg 23:112–116
Vergote T, Revol M, Servant JM, Banzet P (1992) Utilisation du lambeau libre de grand dorsal dans la reconstruction des exenterations orbitaires elargies. Ann Chir Plast Esthet 37:525–533
von Arlt JA (1874) Exenteratio orbitae. In: Graefe A, Saemisch T (eds) Handbuch der gesamten Augenheilkunde. Engelmann, Leipzig [cited by Henderson JW (1973) Orbital tumors. Saunders, Philadelphia]
Wheeler JM (1922) The use of epidermic graft in plastic eye surgery. Int Clinics 3:292–296
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mohr, C., Esser, J. Orbital exenteration: Surgical and reconstructive strategies. Graefe's Arch Clin Exp Ophthalmol 235, 288–295 (1997). https://doi.org/10.1007/BF01739638
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01739638