The appropriate choice of orbital implant for fracture repair ensures appropriate orbital reconstruction in an effort to alleviate diplopia, enophthalmos, orbital dystopia, and extraocular muscle restriction.

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Background Approximately 30% of patients with metastatic (stage M) neuroblastoma present with periorbital ecchymosis from orbital osseous disease. Though locoregional disease is staged by imaging, the prognostic significance of metastatic site in stage M disease is unknown. We hypothesize that, compared to non-orbital metastasis, orbital metastasis is associated with decreased survival in patients with stage M neuroblastoma, and that periorbital ecchymosis reflects location and extent of orbital disease. Procedure Medical records and imaging from 222 patients with stage M neuroblastoma seen at St. Jude Children’s Research Hospital between January 1995 and May 2009 were reviewed. Thirty-seven patients were <18 months of age at diagnosis and 185 were ≥18 months. Overall (OS) and 5-year survival (5YS) were compared for patients with and without orbital, calvarial and non-orbital osseous metastasis, and with and without periorbital ecchymosis (log-rank test). Associations of periorbital ecchymosis with orbital metastasis location/extent were explored (fisher’s exact test, t-test). Results In patients ≥18 months of age, only orbital metastasis was associated with decreased 5YS (p=0.0323) and OS (p=0.0288). In patients <18 months of age, neither orbital, calvarial or non-orbital bone metastasis was associated with OS or 5YS. Periorbital ecchymosis was associated with higher number of involved orbital bones (p=0.0135), but not location or survival. Conclusions In patients ≥ 18 months of age with stage M neuroblastoma, orbital metastatic disease is associated with decreased 5YS and OS. In future clinical trials, orbital disease may be useful as an imaging-based risk factor for sub-stratification of stage M neuroblastoma.

Endonasal DCR is a simple and effective approach to surgically treat NLDO and offers success rates comparable with external DCR.

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