Surgical Approaches to the Orbit

Intact Removal of Orbital Lobe Tumors of the Lacrimal Gland, With or Without Lateral Wall Osteotomy

“…Intact excision of PAs is mandatory because disruption of them carries an unacceptably high risk of recurrence by seeding throughout the orbit, [1][2][3][4] and malignant mixed tumors should, where possible, be excised intact as this improves the prognosis for this malignancy. 5 The traditional approach to intact excision of well-defined orbital lobe masses is through a lateral wall osteotomy, 4,[6][7][8] this continuing to be advocated in the literature, 9,10 and such osteotomy does simplify access to the posterior pole of the gland, where the lacrimal neurovascular bundle enters. Visualization of this vascular supply facilitates the hemostasis needed before the tumor is swung forward and then excised intact by division of the "isthmus" between the orbital and palpebral lobes.…”