Craniofacial Surgery in the Orbit and Periorbital Region

Abstract

Orbital reconstruction after ablative cancer surgery is one of the most challenging procedures in facial reconstruction. Thorough knowledge of the anatomy of the orbit and its contents is critical for successful orbital reconstruction. The principal objectives of orbital reconstruction are (1) to provide support to the orbital contents to avoid displacement of the globe and diplopia; (2) to prevent ascending infections by obliterating any communication between the orbit and the nose, mouth, nasopharynx, and anterior skull base; (3) to reconstruct the palatal surface to enhance articulation and deglutition; (4) to reconstruct the lacrimal apparatus; and (5) to provide enough tissue volume to achieve facial symmetry and a good aesthetic result. Following maxillectomy with orbital exenteration, postoperative high-dose adjuvant radiation therapy is often required; therefore, reconstruction usually requires grafting of free tissue flaps from distant donor sites. Reconstruction in patients who have undergone maxillectomy with preservation of the orbital contents but resection of the floor of the orbit can be particularly challenging. The primary goal of reconstruction after orbital exenteration is to either line or fill the orbit with durable tissue that excludes the nasal cavity and paranasal sinuses and, when there is a cranial defect, protects the brain.