Orbital exenteration is the removal of all the orbital contents including the periorbita and eyelids. The aim of exenteration is to achieve local control of disease extending to the orbit while preserving normal tissues whenever possible to optimize surgical rehabilitation. Subtotal exenteration (eyelid sparing, conjunctiva sparing) is a modification of exenteration to aid healing and cosmetic rehabilitation. If the bone of the orbit is invaded, an “extended” exenteration is required that includes resection of the diseased bone. The ethmoids, maxillary wall, and zygomatic bone are commonly resected in extended orbital exenteration. Orbital invasion by periocular cutaneous malignant tumors (basal cell carcinoma, sebaceous gland carcinoma, squamous cell carcinoma, and melanoma) remains the most common indication for orbital exenteration. Other indications include tumors arising in the conjunctiva, orbit, globe, or paranasal sinuses. Orbital reconstruction, an integral component of the procedure, can be achieved by local methods (healing by secondary intention [laissez-faire], split-thickness skin graft, or dermis fat graft), locoregional advancement flaps (pedicle flaps, temporalis muscle transfer, frontalis rotational flap, or temporoparietal fascial flap), or microvascular free flaps.
Howard GR, Nerad JA, Carter KD, et al. Clinical characteristics associated with orbital invasion of cutaneous basal cell and squamous cell tumors of the eyelid. Am J Ophthalmol. 1992;113:123–33.PubMedGoogle Scholar
Madge SN, Khine AA, Thaller VT, et al. Globe-sparing surgery for medial canthal basal cell carcinoma with anterior orbital invasion. Ophthalmology. 2010;117:2222–8.PubMedGoogle Scholar
Raney B, Huh W, Hawkins D, et al., for the Soft Tissue Sarcoma Committee of the Children’s Oncology Group, Arcadia, CA. Outcome of patients with localized orbital sarcoma who relapsed following treatment on Intergroup Rhabdomyosarcoma Study Group (IRSG) Protocols-III and -IV, 1984–1997: a report from the Children’s Oncology Group. Pediatr Blood Cancer. 2013;60(3):371–6. https://doi.org/10.1002/pbc.24289.
Cameron M, Gilbert PM, Mulhern MG, et al. Synchronous reconstruction of the exenterated orbit with a pericranial flap, skin graft and osseointegrated implants. Orbit. 2005;24:153–8.PubMedGoogle Scholar
Shore JW, Burks R, Leone CR Jr, et al. Dermis-fat graft for orbital reconstruction after subtotal exenteration. Am J Ophthalmol. 1986;102:228–36.PubMedGoogle Scholar
Sira M, Malhotra R. Reconstruction of orbital exenteration defects by primary closure using cheek advancement. Br J Ophthalmol. 2013;97(2):201–5.PubMedGoogle Scholar
Goldberg RA, Weinberg DA, Shorr N, et al. Maximal, threewall, orbital decompression through a coronal approach. Ophthalmic Surg Lasers. 1997;28:832–43.PubMedGoogle Scholar
Graham SM, Brown CL, Carter KD, et al. Medial and lateral orbital wall surgery for balanced decompression in thyroid eye disease. Laryngoscope. 2003;113:1206–9.PubMedGoogle Scholar
Bolger WE, Tadros M, Ellenbogen RG, et al. Endoscopic management of cerebrospinal leak associated with the use of bone wax in skull-base surgery. Otolaryngol Head Neck Surg. 2005;132:418–20.PubMedGoogle Scholar
Schaefer SD, Soliemanzadeh P, Della Rocca DA, et al. Endoscopic and transconjunctival orbital decompression for thyroid-related orbital apex compression. Laryngoscope. 2003;113:508–13.PubMedGoogle Scholar
Yassur I, Hirschbein MJ, Karesh JW. Clinicopathologic reports, case reports, and small case series: 0.01% becaplermin gel for the treatment of a chronic orbital ulcer after exenteration. Arch Ophthalmol. 2001;119:1858–9.PubMedGoogle Scholar
Williams LS, Mancuso AA, Mendenhall WM. Perineural spread of cutaneous squamous and basal cell carcinoma: CT and MR detection and its impact on patient management and prognosis. Int J Radiat Oncol Biol Phys. 2001;49:1061–9.PubMedGoogle Scholar