The New Anatomical Classification System for Orbital Exenteration Defect

WOS: 000417057300059PubMed ID: 28834831Background: The unique anatomy of the orbita and the different behavior of each malignant tumor cause us to perform the various types of orbital exenteration that yields to varying defect each ofwhich has own specific demands in terms of the reconstruction. Current classification of orbital exenteration defects seems not to be adequate to provide detailed description. This study reviews 50 exenteration defects to offer a more effective anatomical classification system. Methods: Over a 15 years period, 50 orbital exenteration defects in 47 patients were reconstructed. Defects were categorized according to the resected orbital wall, dura, and ethmoid resection. If the maxillectomy was performed, A or B was added to define the type of maxillectomy as partial (intact palate) or total maxillectomy, respectively. According to these criteria, 4 types of defect patterns were determined including Type 0 (n = 5) with intact orbital wall, Type I (n = 9) with sino-orbital fistula, Type II (n = 4) with crania-orbital fistula with intact dura, Type III (n = 6) with crania-orbital fistula associated with dura defect, and Type IV (n = 8) with cranio-nasal-orbital fistula. There were 12 partial (A) and 6 total maxillectomy (B) defects along with the orbital exenteration. Results: There was no major complication except one. The minor wound-healing problems occurred in 7 patients. Nine patients (19%) used prosthesis. Twenty-two (46.8%) patients chose a patch to cover the area. The remaining 16 patients were not able to use any type of prosthesis because of the reconstruction methods. Conclusion: The authors believe that the authors' anatomical classification system provides more precise description of the defect which eventually enhances the success rate of both reconstruction and resection

Periocular squamous cell carcinoma

The definitive version is available at www.blackwell-synergy.comSquamous cell carcinoma (SCC) is the second most common eyelid malignancy and its incidence is increasing. Because of its variable clinical presentation, SCC may be difficult for even the experienced clinician to diagnose. Hence, all suspicious lesions warrant biopsy. As SCC behaviour may range widely in aggression, management should be individualized based on tumour (e.g. size, location, grade, histological subtype, previous recurrence, perineural invasion) and patient factors (e.g. age, health). Treatment of eyelid SCC should include margin control whenever possible for the highest cure rate in this high-risk area. Immediate histological monitoring of surgical margins with frozen sections or Mohs’ micrographic surgery also allows for smaller margins of excision in an area where tissue conservation is important. Other special considerations in the periocular area include maintaining a high level of suspicion for perineural invasion as this may be associated with a poorer prognosis.Vanessa Limawararut, Igal Leibovitch, Tim Sullivan and Dinesh Selv

Recurrent multiple cavernous hemangiomas of the orbit in association with systemic tumors

PurposeTo report the clinical findings and management of multiple, recurrent cavernous hemangiomas of the orbit in a patient with concurrent liver involvement.DesignInterventional case report.MethodsAn analysis of clinical findings, radiology and treatment was conducted with a literature review.ResultsA 35-year-old woman with blurry vision and proptosis was found to have multiple cavernous hemangiomas of the orbit. The tumors were excised completely without complication, and the patient subsequently regained her vision. Fifteen years later, the patient had recurrent, multiple cavernous hemangiomas in the same orbit. Further investigations for vague back pain revealed a presumed cavernous hemangioma in the liver and a presumed schwannoma arising from the neural foramen of the spine at the level of T2 through T4.ConclusionMultiple cavernous hemangiomas may recur after complete excision and may exist with concurrent systemic tumors.Vanessa Limawararut, Garry Davis, John Crompton, Igal Leibovitch and Dinesh Selvahttp://www.elsevier.com/wps/find/journaldescription.cws_home/601028/description#descriptio

Squamous cell carcinoma presenting as an orbital cyst with radiologic evidence of perineural invasion

PurposeTo report clinical and radiologic findings of cystic squamous cell carcinoma (SCC) of the orbit with evidence of perineural involvement.MethodsAnalysis of clinical findings and radiology with a literature review.ResultsA 66-year-old man with SCC of the forehead 8 years prior presented with paraesthesias, diplopia, and proptosis. Magnetic resonance imaging showed a well-defined, cystic mass of the orbit with a single, linear structure running through its center. Lateral orbitotomy revealed a cyst adherent to adjacent periorbita containing viscous, clear, yellow substance and a nerve coursing through the center. Histopathology confirmed poorly differentiated spindle cell carcinoma with positive staining for cytokeratin markers, consistent with SCC.ConclusionsOrbital cysts associated with altered sensation are suggestive of SCC with perineural spread, requiring prompt investigation and treatment to minimize morbidity and mortality. The involved nerve may be seen as a single, linear structure within the mass on imaging

Novel technique to control hypersecretion from a transplanted autologous submandibular salivary gland for keratoconjunctivitis Sicca

PurposeTo present a novel technique to control hypersecretion from a transplanted autologous submandibular gland (SMG) in a patient with keratoconjunctivitis sicca.MethodsA 65-year-old man presented with corneal epithelial edema and suspicious ocular surface dysplasia secondary to hypersecretion from a transplanted autologous SMG. The location and function of the gland were evaluated perioperatively using technetium-99m-pertechnetate scintigraphy. The course of the duct was marked with a radiation probe, surgically exposed, and partially ligated with titanium clips.ResultsMarked reduction in salivary flow and resolution of corneal edema and ocular surface changes were noted. Conjunctival biopsy showed no evidence of malignancy. Symptoms were stable during a 1-year follow-up period.ConclusionPartial ligation of the transplanted SMG duct may be a simple and reversible technique to control hypersecreting glands with secondary corneal edema and ocular surface changes.Igal Leibovitch, Erika Hoyama, Vanessa Limawararut, John Crompton and Dinesh Selv

Tarsomarginal graft in upper eyelid coloboma repair

Copyright © 2007 American Association for Pediatric Ophthalmology and Strabismus Published by Mosby, Inc.Eyelid colobomas are congenital defects caused by failure of fusion of the mesodermal lid folds. The timing and approach to surgical repair depend on the severity of the defect and exposure keratopathy. Tarsomarginal grafts have been well described in eyelid reconstructions following tumor excision. Descriptions of lid coloboma repair using this approach are limited. We describe a series of upper lid colobomas repaired with the tarsomarginal graft.Erika Hoyama, Vanessa Limawararut, Raman Malhotra, James Muecke and Dinesh Selvahttp://www.elsevier.com/wps/find/journaldescription.cws_home/623140/description#descriptio

Blinding orbital cellulitis: A complication of strabismus surgery

A 56-year-old healthy man underwent left medial rectus recession and lateral rectus resection for esotropia. The next day he developed severe left periocular pain with decreased vision, an afferent pupillary defect, periorbital edema, limited ocular motility, and proptosis. Computed tomography showed fat stranding and less than 90 degrees of posterior globe tenting. Despite intravenous antibiotics to treat orbital cellulitis, and a lateral canthotomy and cantholysis to decompress the orbit, visual acuity worsened to no light perception. The patient underwent emergent orbital decompression including release of the superior and inferior septum and outfracturing of the orbital floor and medial wall; however, there was no recovery of vision. Blinding orbital cellulitis is a rare complication after strabismus surgery. Despite poor prognosis, prompt diagnosis and aggressive treatment may maximize visual potential