Advertisement

Exenteration

  • Usiwoma Abugo
  • Kimberly Cockerham
Chapter

Abstract

Orbital exenteration was first described by Georg Bartisch in 1583. Exenteration involves the removal of all orbital contents including fat, nerves, periorbital, conjunctiva, lacrimal sac, lacrimal gland, globe, and conjunctiva. Depending on the extent and focus of the tumor, part or all of the eyelids and varying amounts of the surrounding skin and bone may also need to be removed. This procedure is routinely reserved for potentially life-threatening malignancies or progressive conditions that are unresponsive to other treatments. Less commonly, this procedure may aide in palliation of severe deformity, pain, or unrelenting infection.

Exenteration is a psychologically and anatomically disfiguring procedure. Prior to proceeding with this procedure, an extensive discussion with the patient and the family is indicated. In many cases, involvement of the primary care physician and oncologist (or infectious disease specialist if applicable) is helpful. Alternatives should be discussed including subtotal exenteration, radiation, chemotherapy, and the risk of not proceeding with exenteration. Intracranial imaging, lymph node dissection, and laboratory evaluation should be performed to confirm the malignancy is isolated to the orbit prior to scheduling this surgical procedure. Informed consent should include why the procedure is indicated, what the procedure involves, potential risks, and proposed reconstruction.

Keywords

Orbital exenteration Orbital tumors Orbital reconstruction Orbital surgery Total exenteration Subtotal exenteration Invasive orbital tumors Orbital tumor management Periocular skin cancer Orbital infections Orbital trauma Congenital deformities 

Supplementary material

419986_5_En_46_MOESM1_ESM.mp4 (240.8 mb)
Video 46.1 Exenteration with placement of a split-thickness skin graft. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Exenteration-w-placement-split-thickness-skin-graft.htm (MP4 246570 kb)
419986_5_En_46_MOESM2_ESM.mp4 (103.2 mb)
Video 46.2 Split-thickness skin graft. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Split-thickness-skin-graft.htm (MP4 105692 kb)
419986_5_En_46_MOESM3_ESM.mp4 (149.4 mb)
Video 46.3 Lid-sparing exenteration. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Lid-sparing-exenteration.htm (MP4 152934 kb)
419986_5_En_46_MOESM4_ESM.mpeg
Video 46.4 Exenteration in patient with large adenoid cystic carcinoma. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/9/exenteration-lrg-adenoid-ca.htm (MPEG 250292 kb)

References

  1. 1.
    Bartisch G. Ophthalmodouleia Das ist Augendienst. Dresden; 1583.Google Scholar
  2. 2.
    Rahman I, Cook AE, Leatherbarrow B. Orbital exenteration: a 13 year Manchester experience. Br J Ophthalmol. 2005;89(10):1335–40.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ackuaku-Dogbe E. Review of orbital exenterations in Korle-Bu teaching hospital. Ghana Med J. 2011;45(2):45–9.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Ackuaku-Dogbe EM, Biritwum RB, Briamah ZI. Psycho-social challenges of patients following orbital exenteration. East Afr Med J. 2012;89(12):385–9.PubMedGoogle Scholar
  5. 5.
    Bhat MT, Hegde HV, Santhosh MC, Rao RP. Orbital exenteration under trigeminal block: an innovative method of regional anesthesia. Saudi J Anaesth. 2013;7(4):470–3.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pollack RS. Orbital and periorbital tumors. Indications for exenteration. Calif Med. 1959;91:207–11.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Rodriguez-Prieto MA, Alonso-Alonso T, Toribio-Garcia JA, Mateos-Hernandez A. Young patient with eyelid Merkel carcinoma: Mohs microsurgery versus exenteration. Arch Soc Esp Oftalmol. 2009;84(11):581–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Shinder R. Risk factors for orbital exenteration in periocular basal cell carcinoma. Am J Ophthalmol. 2012;154(1):212, author reply 212–3.CrossRefPubMedGoogle Scholar
  9. 9.
    Benazzou S, Arkha Y, Boulaadas M, Essakalli L, Kzadri M. Orbital exenteration. Rev Stomatol Chir Maxillofac. 2011;112(2):69–74.CrossRefPubMedGoogle Scholar
  10. 10.
    Kato JM, Fonseca FL, Matayoshi S. Survival following orbital exenteration at a tertiary brazilian hospital. Rev Col Bras Cir. 2016;43(1):42–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Kaur A, Khattri M, Jaiswal V. Pattern of orbital exenteration at a tertiary eye care centre in North India. Nepal J Ophthalmol. 2012;4(1):64–7.PubMedGoogle Scholar
  12. 12.
    Mbarek C, Zribi S, Khamassi K, Hariga I, Ouni H, Ben Amor M, et al. Rhinocerebral mucormycosis: five cases and a literature review. B-ENT. 2011;7(3):189–93.PubMedGoogle Scholar
  13. 13.
    Levine M. Manual of oculoplastic surgery. 4th ed. Thorofare: Slack Incorporated; 2010.Google Scholar
  14. 14.
    Wladis EJ, Kattato DF, De A. Intravenous acetaminophen in orbital surgery. Ophthal Plast Reconstr Surg. 2016;32(3):211–3.CrossRefPubMedGoogle Scholar
  15. 15.
    Yeatts RP. The esthetics of orbital exenteration. Am J Ophthalmol. 2005;139(1):152–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Cooper J. Cavity dressings in orbital exenteration wounds. J Wound Care. 2012;21(5):235.PubMedGoogle Scholar
  17. 17.
    El Khamary SM, Galindo-Ferreiro A, Akaishi P, Muinos-Diaz Y, Cechetti SP, Cintra MB, et al. Hyperostosis following orbital exenteration. Ophthal Plast Reconstr Surg. 2017;33:241–3.CrossRefGoogle Scholar
  18. 18.
    Loewenstein A, Foster J. Fatty embolism of the retinal artery found in eyes after enucleation and orbital exenteration. Br J Ophthalmol. 1948;32(11):819–23.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Gonzalez LF, Bilyk JR. Intracranial arterial avulsion during orbital exenteration. Orbit. 2012;31(3):190–3.CrossRefPubMedGoogle Scholar
  20. 20.
    Massoud VA, Fay A, Yoon MK. Cerebrospinal fluid leak as a complication of oculoplastic surgery. Semin Ophthalmol. 2014;29(5–6):440–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Shieh WS, Farrell C, Curry J, Murchison AP, Bilyk JR. Tension pneumocephalus following orbital exenteration. Ophthal Plast Reconstr Surg. 2016;32(1):e3–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Bilge AD, Yazici B, Kasapoglu F. Reconstruction of orbital exenteration defects with bilobed forehead flap. Int Ophthalmol. 2016;36:861–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Chang EI, Hanasono MM. State-of-the-art reconstruction of midface and facial deformities. J Surg Oncol. 2016;113(8):962–70.CrossRefGoogle Scholar
  24. 24.
    Uyar Y, Kumral TL, Yildirim G, Kuzdere M, Arbag H, Jorayev C, et al. Reconstruction of the orbit with a temporalis muscle flap after orbital exenteration. Clin Exp Otorhinolaryngol. 2015;8(1):52–6.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Motomura H, Iguchi H, Hatano T, Kobayashi R, Sakahara D, Fujii N, et al. Dynamic eye socket reconstruction after extensive resection of midfacial malignancies: preliminary results using temporalis transfer. Acta Otolaryngol. 2014;134(11):1205–10.CrossRefPubMedGoogle Scholar
  26. 26.
    Jaquet Y, Higgins KM, Enepekides DJ. The temporoparietal fascia flap: a versatile tool in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2011;19(4):235–41.CrossRefPubMedGoogle Scholar
  27. 27.
    Torroni A, Cervelli D, Gasparini G, Grussu F, Moro A, Marianetti TM, et al. Anterior retrograde approach to the myofascial temporalis muscle for orbital reconstruction: series of 9 consecutive cases. Ann Plast Surg. 2015;74(1):37–42.CrossRefPubMedGoogle Scholar
  28. 28.
    Altindas M, Yucel A, Ozturk G, Sarac M, Kilic A. The prefabricated temporal island flap for eyelid and eye socket reconstruction in total orbital exenteration patients: a new method. Ann Plast Surg. 2010;65(2):177–82.CrossRefPubMedGoogle Scholar
  29. 29.
    Melicher Larson JS, Nerad JA. The use of osseointegration and rare earth magnetic coupling for oculofacial prosthesis retention in the exenterated orbit. Curr Opin Ophthalmol. 2009;20(5):412–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Joseph ST, Thankappan K, Mathew J, Vijayamohan M, Sharma M, Iyer S. Defect components and reconstructive options in composite orbitomaxillary defects with orbital exenteration. J Oral Maxillofac Surg. 2014;72(9):1869.e1–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Usiwoma Abugo
    • 1
  • Kimberly Cockerham
    • 2
  1. 1.Department of OphthalmologyCentral Valley Eye Medical GroupStocktonUSA
  2. 2.Department of OphthalmologyStanford University, Central Valley Eye Medical GroupStocktonUSA

Personalised recommendations