A retrospective nonrandomized study of orbital exenterations performed between 1990 and 2010 for malignant tumors of the skin, paranasal sinus. Total exenteration entails removing the orbital contents in their entirety. Read through this guide at least once before your surgery and use it as a. This color atlas is a unique visual learning tool for the surgeon planning and performing orbital operative procedures. Endoscopic surgery of the orbit offers stateoftheart, expert guidance on minimally invasive orbit techniques that promise a more streamlined approach to comprehensive patient care, improved patient satisfaction, and superior outcomes. Newer reconstructive efforts with free flaps allow adjuvant radiotherapy, which is often imperative in adnexal malignancies. Eye removal current indications and technical tips. Indications for the multilating operation of exenteration are enumerated. Prosthetic rehabilitation of surgically treated orbital. Endoscopic orbital procedures are at the forefront of todays multidisciplinary patient care and team approach to problemsolving. Maintain sterile technique as measured by recognized breaks in technique. Technically, orbital exenteration has several variations, each with its own indications.
Start studying chapter 27 ophthalmic surgery 222 unit. Outline indications types of anophthalmic socket operations orbital implants complications 3. Orbital exenteration is the removal of all the orbital contents including the periorbita and eyelids. In a recent article describing a useful wellknown technique for reconstruction after orbital exenteration, uusitalo and coworkers 1 described a patient who underwent orbital exenteration for primary rhabdomyosarcoma. This is an open access article distributed under the terms of the creative commons attribution. Online retailer of specialist medical books, we also stock books focusing on veterinary medicine. Featuring more than 500 fullcolor drawings and photographs and nearly 200 radiographic images, the book enables the surgeon to visualize the anatomic structures of the orbit, the pathologic changes affecting these structures, and the surgical techniques used for specific. Finally, the book concludes with chapters on prosthetic options including scleral shells, keratopigmentation procedures.
Included in the log book is a list of surgical procedures and the specialty which they are. Your doctor and care team will share instructions for surgery preparation. Orbital exenteration is defined as removal of all the orbital contents including the periorbita and eyelids. The eye and all orbital contents are cut at the orbital apex and removed. Surgical procedures of orbital exenteration on during orbital exenteration, the eye and surrounding bone and sinuses are removed. The surgery may be extended to include orbital exente. We will discuss the technique of orbital exenteration in general terms. Details of technique, relevant anatomical considerations and discussion of reconstructi. Exenteration is a surgical procedure consisting of removing the orbital contents either partially or fully.
This study presents the role of the temporalis muscle flap in primary reconstruction after orbital exenteration. The new edition describes more than 80 of the most common. Exenteration is a surgical procedure consisting of removing the orbital contents either partially or fully depending on the location of the intraocular and eyelid tumour. An evisceration is the removal of the eyes contents, leaving the scleral shell intact. When considering which technique to use, it is important to realize that often times it is the type of disease has a much greater impact on the survival of patients undergoing exenteration surgery than the type of exenteration surgery or the disease status of surgical margins 7. We find this surprising because the intergroup rhabdomyosarcoma study found a 10year overall survival rate of 87% with use of chemotherapy with or without adjunctive. A wellplanned surgical technique with adequate volume replacement. The procedure is usually performed to reduce pain or improve cosmesis in a blind eye, as in cases of endophthalmitis unresponsive to antibiotics. Wiley online library will be unavailable on saturday 27th february from 09. A surgical technique for the reconstruction of the totally contracted ocular socket allen m. Exenteration is an aggressive surgery but if done correctly can be lifesaving.
This psychologically and anatomically disfiguring procedure is reserved to treat potentially life threatening malignancies or relentlessly progressive conditions unresponsive to. With the patient in a supine position under general anesthetic, a lid speculum is inserted. A slide set of orbital surgery will also be available from lippincottraven. Anophthalmic socket and orbital reconstruction haitham almahrouqi oculoplasty course may 2019 2. Evisceration, enucleation and exenteration this chapter describes three operations that either remove the contents of the eye evisceration, the eye itself enucleation or the whole orbital contents exenteration. Exenteration of the orbit in a patient with sebaceous cell carcinoma. Orbital exenteration, moorfields eye hospital technique. However, even an exquisite surgical technique cannot prevent complications in the. Prosthetic rehabilitation of surgically treated orbital defects. Enucleation, evisceration, and exenteration of the eye. This guide will help you get ready for your total pelvic exenteration surgery at memorial sloan kettering msk. Order your resources today from wisepress, your medical bookshop. Each procedure listed in this section describes a slightly different extent of eye and eye.
Evisceration, enucleation, and exenteration are the three main surgical options. This 2nd edition of orbital surgery is actually three books in one. Although a disfiguring procedure, orbital exenteration can provide a cure in certain locally invasive tumors including basal and squamous cell carcinoma. Eye removal current indications and technical tips, advances in eye surgery, patricio a. This is the removal of all eye socket contents, including. This video demonstrates a lid sparing exenteration. Surgical procedure log book new england institute of. Although a disfiguring procedure, orbital exenteration can provide a cure in certain.
The technique is applicable only in patients with a primary malignant orbital tumor which is confined to the intraorbital space posterior to the. Operative dictations in ophthalmology touches on important steps within each surgical case, indications for the procedure, possible complications, and a sample dictation. Orbital exenteration, first described by george bartisch in 1583, 1 is a radical procedure consisting of removal of the orbital contents, including orbital fat, conjunctival sac, globe, and part or all of the eyelids. Technique of orbital exenteration utilizing methyl. 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.
An ocular prosthetic can be fitted over the eviscerated eye in order to improve cosmesis either general or local anesthetics may be used. Operative dictations in ophthalmology touches on important steps within each surgical case, indications for the procedure, possible. A periosteal elevator is used to separate periorbita from the bony socket. The removal of the eyeball with or without other orbital tissues is always a. Most ophthalmologists consider orbital exenteration to be a radical surgical procedure. Orbital exenteration is the surgical removal of the orbital contents. Using a conceptual model, along with more than 800 photographic and handdrawn illustrations this book provides the reader with a clear. The incision is extended through periosteum around the orbital rim. Demographics, histology, surgical management, complications, locoregional control. An orbital exenteration refers to the surgical removal of the eyeball and the surrounding tissues, these including the eyelids the extent depending on the disease being treated, and the muscles, nerves and fatty tissue adjacent to the eye. It will also help you understand what to expect during your recovery. The howto guide to stateoftheart surgical treatments for eye disorders authored by worldrenowned eye surgeons and teachers, the second edition of this book is a stepbystep guide to common eye surgery and laser procedures. This textbook serves as both a practical guide and useful reference for surgical techniques involving the orbit and adnexa.
Orbital exenteration with splitthickness skin graft. An evisceration is the removal of the eyes contents, leaving the scleral shell and extraocular muscles intact. It is a practical complement to the concepts and environments covered in the companion volume, basic principles of ophthalmic surgery, fourth edition. Skin malignant tumours, surgical treatment, orbital exenteration, skin graft. Exenteration is a major operation during which all the contents of a body cavity are removed. Reconstruction of the orbit with a temporalis muscle flap. A retrobulbar block and local subconjunctival injection of anesthetic can be administered prior to initiating surgery but is not necessary unless intravenous sedation is used.
The text and graphic presentation aid the surgeon in developing a thorough understanding of anatomy, pathology, and surgical technique and applying this knowledge in surgical decisionmaking. Enucleation, evisceration, and exenteration plastic. Orbital exenteration is a disfiguring procedure which typically involves removal of. Exenteration definition of exenteration by medical. The purpose of this report is to describe a technique of orbital exenteration which replaces the orbital defect with methyl methacrylate and utilizes the skin of the lids to close the orbital wound. Novel use of unilateral galeopericranial flaps for closure of sinoorbital. Chapters are then grouped into separate sections that address cataracts, corneal diseases. Orbital exenteration for squamous cell carcinoma of. Additional readings books mobile apps helpful products video library. Orbital exenteration is a complex procedure with many different approaches and reconstruction considerations. Eye removal current indications and technical tips intechopen. The aim of this study was to investigate the course of reconstructive treatment and outcomes with use of free flaps after orbital exenteration for malignancy. Orbital exenteration is defined as the surgical excision of the ocular globe, orbital soft tissues, and ocular adnexa. The same surgical approach was proposed for certain cases of exophthalmos.
We will touch on some orbital prostheses and some advanced socket procedures that can prevent loss of the eye. This book is a landmark in ophthalmic publishing, providing for the first time in a single resource comprehensive information on the evaluation and management of patients requiring enucleation, evisceration, or exenteration. About your total pelvic exenteration surgery memorial. An exenteration is the removal of the entire orbital contents, including the eye, extraocular muscles, fat, and connective tissues.
Interdisciplinary surgical management of orbital and maxillo ethmoidal complex disorders. Basic techniques of ophthalmic surgery is an essential textbook for any ophthalmology resident or trainee and will help them build a solid foundation of ophthalmic surgical knowledge. Reconstruction after orbital exenteration using gracilis. They usually involve a malignant neoplasm of the orbital contents, primary, direct. Orbital exenteration was performed in 102 patients at the mayo clinic during the 20year period from 1967 through 1986. The surgical procedure was performed for mucormycosis in one patient and for. Exenteration procedure, recovery, blood, tube, removal. Interdisciplinary surgical management of orbital and.
Pdf orbital exenteration is defined as the surgical excision of the ocular globe, orbital soft tissues, and ocular adnexa. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Skin is incised around the eyelids and all visible tumor. Two 40 silk sutures are placed as tarsorrhaphy sutures as well as traction sutures. Pelvic exenteration refers to the removal of the pelvic organs and adjacent structures.
Debraj shome is a highly experienced expert in oculoplastic surgery and has several accolades to his name. Exenteration is surgical removal of the eye and its orbital contents including the extraocular muscles, orbital fat, nerves, lids, lashes, lachrymal gland, and occasionally brow. Anophthalmic socket evisceration, enucleation, exenteration 1. Orbital exenteration with ethmoidectomy, suprastructu ral maxillectomy and reconstruction with free transverses rectus abdominus m yocutaneous tram flap for rerecurrent basal cell carcinoma of eyelid. Surgical procedures on eyeball are undertaken mainly by opthalmologists,but no particular specialty has been yet dedicated. Indications and surgical techniques for orbital exenteration. Part ii and iii discuss surgical removal techniques, prosthesis fitting and maintenance, congenital anophthalmia, infections and inflammations, and newer surgical techniques such as osseointegration after orbital exenteration. The patient has a history of an orbital sarcoma which was previously biopsied through a transconjunctival incision.
Langenbeck in 1821 and dupuytren in 1833 were the earliest to undertake this surgical technique. Exenteration surgery is a significant surgical procedure and must only be carried out by an experienced and licensed oculoplastic surgeon to avoid any postoperative complications. He explained everything i needed to know about my issue with detail and attention, putting me at ease and giving me confidence to. Orbital exenteration is a disfiguring procedure which typically involves removal of the entire contents of the orbit including the periorbita, appendages, eyelids and, sometimes, a varying amount of surrounding skin. Operative dictations in ophthalmology eric rosenberg. Karesh temporalis muscle transfer in the treatment of the severely contracted socket giukio bonavolonta dermisfat orbital implantation and complex socket deformities stephen l. Orbital exenteration for squamous cell carcinoma of conjunctiva. They usually involve a malignant neoplasm of the orbital contents, primary, direct extension, or adnexal tissue that cannot be controlled by simple excision or irradiation. Anophthalmic socket evisceration, enucleation, exenteration. An atlas of orbital surgery depicts regional approaches to the anterior orbit, midorbit, and apical orbit and techniques for combined orbital and periorbital lesions.
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