Assessment and Treatment of Facial Deformity Resulting from Radiation to the Orbital Area in Childhood

Abstract

Children who receive radiation for malignant tumors in the orbital area frequently develop widespread craniofacial deformities. These affect the skull, orbit, maxilla, and mandible. When these patients seek treatment at a later age, they require careful assessment using cephalometrics and three-dimensional imaging. It is recommended that the four levels of skeletal deformity be corrected in a single procedure, that is frontotemporal expansion with repositioning of the skull base area, orbital expansion and repositioning together with maxillary and mandibular surgery. Bone grafts should be inlay rather than onlay and soft tissue should be supplied by free-tissue transfer. This counteracts any residual ischemia related to the previous radiation therapy. The second surgical stage is designed to reconstruct the socket and the eyelids to allow more satisfactory rehabilitation with an ocular prosthesis. In patients who have a globe present, the usual enophthalmos can be corrected by repositioning of the eye as part of the first procedure by reducing the anteroposterior dimensions of the socket. In bilateral cases, the deformity is hourglass in nature and requires correction in the frontal and temporal area with lateral displacement of the orbits. A bimaxillary procedure is also indicated. It is emphasized that to formulate a satisfactory operative plan an in-depth three-dimensional analysis of the deformity is mandatory.

Non‐traumatic enophthalmos: a review

“…Orbital radiation in children, usually for retinoblastoma or rhabdomyosarcoma, is a well‐known cause of enophthalmos that develops later in life (Jackson et al. 1996).…”

Use of dermal-fat grafts in the post-oncological reconstructive surgery of atrophies in the zygomatic region: clinical evaluations in the patients undergone to previous radiation therapy

“…Although the 5-year survival rate of patients with orbital unilateral rhabdomyosarcoma is beyond 85%, the extent of eradication therapy and of the subsequent radiation therapy has a destructive impact on the treated area [4-6]. …”

“…These patients often present with adipose tissue atrophy associated with deforming fibrotic conditions; these biological manifestations result from the radiations affecting that area [6,7]. …”

“…Enucleation of the eye, especially in small children, can cause atrophy of the corresponding hemiface and decreased orbital growth, which create reluctantly accepted aesthetic conditions [6]. …”

A Road Map for Important Centers of Growth in the Pediatric Skeleton to Consider During Radiation Therapy and Associated Clinical Correlates of Radiation-Induced Growth Toxicity

“…Furthermore, the sequelae often lead to lifelong psychological problems. [31][32][33] The limitations in avoiding craniofacial asymmetry and hypoplasia are inherent in the treatment of head and neck tumors, which most often present with a laterality. When uninvolved by tumor, avoidance of growth centers in the ipsilateral and contralateral face should be attempted.…”