An Algorithmic Approach to Reconstructive Surgery and Prosthetic Rehabilitation after Orbital Exenteration

Hanasono, Matthew M.; Lee, Johnson C.; Yang, Jenq-Lin; Skoracki, Roman J.; Reece, Gregory P.; Esmaeli, Bita

doi:10.1097/prs.0b013e3181904b95

Cited by 122 publications

(94 citation statements)

References 12 publications

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“…If the patient desires an orbital prosthesis, reconstruction with thin flaps results in a concave orbital cavity that is suited to prosthetic retention. 13 A temporalis muscle pedicled flap can also be used to resurface the orbital cavity, particularly if the lateral wall of the orbit is removed.…”

Section: Discussionmentioning

confidence: 99%

“…3). 13 One drawback of bulkier flaps is that prosthetic retention may be difficult and the prosthesis may protrude unnaturally because of the lack of a concave orbit. Resections that occur in combined regions I and II usually involve orbitomaxillectomies (79.5 percent of the resections in combined regions I and II in this series) and are reconstructed in a manner identical to those orbitomaxillectomies that only involve region I, with a bulky free flap that fills both the orbit and the sinus cavities.…”

Section: Discussionmentioning

confidence: 99%

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Skull Base Reconstruction

Hanasono

Silva

Skoracki

et al. 2011

Plastic and Reconstructive Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Skull Base Reconstruction

Hanasono

Silva

Skoracki

et al. 2011

Plastic and Reconstructive Surgery

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“…Reconstructive surgery with a temporalis flap or a free flap to fill the socket may be utilized in certain settings, for example when adjuvant radiation therapy is planned. [6][7][8] Specialized ocular prosthetics post-operatively may help patients to achieve an acceptable cosmetic result.…”

Section: Introductionmentioning

confidence: 99%

Orbital exenteration: The 10-year Massachusetts Eye and Ear Infirmary experience

Nagendran

Lee

Fay

et al. 2016

Orbit

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The authors report their experience with orbital exenteration surgery at one academic institution over a 10-year period and review the literature. This retrospective cohort study monitored outcomes of all patients who underwent orbital exenteration surgery at Massachusetts Eye and Ear Infirmary between January 2003 and January 2013. Patients with no follow-up data or survival data were excluded from the study. The main outcome measures were surgical complications, disease status of surgical margins, need for adjuvant treatment, local recurrence, metastases and survival. 23 patients with malignancy and 2 with mucormycosis met inclusion criteria for the study. Surgical procedures included non-lid sparing total exenteration (44%), lid-sparing total exenteration (32%), non-lid sparing partial exenteration (8%) and lid-sparing partial exenteration (16%). 44% underwent additional extra-orbital procedures. Survival rates were 72% at 1 year, 48% at 3 years, and 37% at 5 years. Of patients with malignancies, 48% had clear margins after exenteration. There was no statistically significant difference in survival between patients with negative surgical margins compared to positive margins (p = 0.12). Mortality was highest in patients with melanoma (85.7%) and lowest in patients with non-squamous cell lid malignancies (0%). Our study suggests that the type of disease has a much greater impact on the survival of patients undergoing exenteration surgery than the type of exenteration surgery or the disease status of surgical margins. Patients with non-squamous cell lid malignancies and localized orbital disease have the best prognosis for tumor eradication from this radical and highly disfiguring surgery.

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“…We and other authors, however, consider preoperative or postoperative radiation therapy a contraindication to skin graft reconstruction alone because of the risk of poor graft take or subsequent graft loss [22,23]. The TPF flap has been used successfully to recreate the internal lining of the empty sockets in preparation for an orbital prosthesis, providing vascularity to cover irradiated bone and to allow maximal skin graft take [23,24].…”

Section: Orbitomaxillary Reconstructionmentioning

confidence: 98%