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A 77-year-old Asian female with a history of left orbit exenteration and lid-sparing reconstruction for recurrent sebaceous carcinoma presented with fluid-like sensation of the left orbit. Magnetic resonance imaging (MRI) demonstrated bright T2 signal and a cyst-like cavity within the exenterated orbit. Decision was made to proceed with surgical exploration and excision. A calcified, bone-like cavity was encountered intraoperatively and removed. Histopathology revealed dense fibrous connective tissue with areas of calcification without osseous metaplasia, suggestive of retained blood in the orbit that underwent dystrophic calcification. This case report illustrates a rare occurrence of a bone-like calcific cyst following exenteration. [ABSTRACT FROM AUTHOR]

Orbital exenteration is a radical and disfiguring surgery mainly performed for treating orbital malignancies. Recently, several studies found favorable results in terms of overall survival with eye-sparing surgeries combined with targeted therapies and/or radiotherapy. The aim of this study was to assess the incidence of orbital exenteration and its evolution in France between 2006 and 2017. A national observational cohort study was conducted in France between January 2006 and December 2017. Data were collected from the national PMSI (Programme de Médicalisation des Systèmes d'Information) database provided by the CNAM (Caisse Nationale de l'Assurance Maladie). All patients undergoing orbital exenteration over the study period in France were included. One thousand and fifty-seven patients were included. The mean annual number of orbital exenterations was 88.1 (63–117), corresponding to a mean incidence of 0.1/100,000 inhabitants/year. A male predominance was noted (n = 626, 59.2%). Exenteration was mainly performed between 75 and 79 years. The underlying etiology was available for 821 patients (77.7%): malignancies were the most common (n = 755; 92.0%) followed by infectious diseases (n = 16; 1.9%). Over the study period, no statistical difference in the mean incidence of orbital exenteration was found (p =.132). The mean annual incidence of orbital exenteration was 0.1/100,000 inhabitants in France and was not significantly modified during the study period. [ABSTRACT FROM AUTHOR]

Histopathological examination showed well-differentiated liposarcoma, sclerosing variant with areas showing cytological atypia and numerous floret like cells (Figure 2C, arrow). Keywords: Liposarcoma; orbital liposarcoma; giant tumo; orbital exenteration EN Liposarcoma orbital liposarcoma giant tumo orbital exenteration 569 570 2 10/06/23 20231001 NES 231001 A 45-year-old female presented with a gradually enlarging painless mass for 8 years associated with diminution of vision, arising from the right orbit. Liposarcoma, giant tumo, orbital liposarcoma, orbital exenteration. [Extracted from the article]

Invasive fungal sinusitis causes painful orbital apex syndrome with ophthalmoplegia and visual loss; the mechanism is unclear. We report an immunocompromised patient with invasive fungal sinusitis in whom the visual loss was due to posterior ischaemic optic neuropathy, shown on diffusion-weighted MRI, presumably from fungal invasion of small meningeal-based arteries at the orbital apex. After intensive antifungal drugs, orbital exenteration and immune reconstitution, the patient survived, but we were uncertain if the exenteration helped. We suggest that evidence of acute posterior ischaemic optic neuropathy should be a contra-indication to the need for orbital exenteration in invasive fungal sinusitis. [ABSTRACT FROM AUTHOR]

Acute invasive fungal sinusitis is a rare disease with a severe and rapidly devastating course. In this report, we describe a case ofRhizopusspp. mucormycosis invading the paranasal sinuses and causing vision loss and confusion. After being biopsied and diagnosed at an outside hospital, the patient was transferred and emergently treated with antifungal therapy and surgical resection by transnasal endoscopic surgery. [ABSTRACT FROM AUTHOR]

In recent decades, the management of sinonasal tumors abutting the orbit has been widely discussed. A real guideline has yet to be proposed, as prospective randomized studies on this topic are very difficult to organize, given the relative rarity of this pathology, the wide spectrum of histologic patterns, and the different clinical behavior of tumors. Nevertheless, in recent years, a better assessment of tumor extension has been obtained thanks to the refinement of preoperative imaging tools and, therefore, more conservative approaches could be adopted, with no worsening of the oncological outcomes and, at the same time, with more attention given to the post-surgical quality of life. Currently, tumors that extend to the bony orbital walls with or without focal infiltration of the periorbit are amenable to orbital preservation. On the other hand, infiltration of extraocular muscles and neurovascular structures are an indication to orbital exenteration. The ideal surgical treatment in cases of limited involvement of orbital fat still remains a matter of debate. We report and discuss the recent English literature on this interesting topic. [ABSTRACT FROM PUBLISHER]

The authors report their experience with orbital exenteration surgery at one academic institution over a 10-year period and review the literature. This retrospective cohort study monitored outcomes of all patients who underwent orbital exenteration surgery at Massachusetts Eye and Ear Infirmary between January 2003 and January 2013. Patients with no follow-up data or survival data were excluded from the study. The main outcome measures were surgical complications, disease status of surgical margins, need for adjuvant treatment, local recurrence, metastases and survival. 23 patients with malignancy and 2 with mucormycosis met inclusion criteria for the study. Surgical procedures included non-lid sparing total exenteration (44%), lid-sparing total exenteration (32%), non-lid sparing partial exenteration (8%) and lid-sparing partial exenteration (16%). 44% underwent additional extra-orbital procedures. Survival rates were 72% at 1 year, 48% at 3 years, and 37% at 5 years. Of patients with malignancies, 48% had clear margins after exenteration. There was no statistically significant difference in survival between patients with negative surgical margins compared to positive margins (p= 0.12). Mortality was highest in patients with melanoma (85.7%) and lowest in patients with non-squamous cell lid malignancies (0%). Our study suggests that 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. Patients with non-squamous cell lid malignancies and localized orbital disease have the best prognosis for tumor eradication from this radical and highly disfiguring surgery. [ABSTRACT FROM PUBLISHER]

Introduction: Orbital exenteration is defined as removal of all the orbital contents including the periorbita and eyelids. Although a disfiguring procedure, orbital exenteration can provide a cure in certain locally invasive tumors including basal and squamous cell carcinoma. Areas covered: This review details the indications and surgical technique of orbital exenteration. This article also elaborates the surgical and non-surgical options for reconstruction and rehabilitation following orbital exenteration. A literature-search was conducted on terms orbital exenteration, indications, technique and reconstruction. All relevant peer-reviewed articles were analyzed. Expert commentary: Orbital exenteration is a radical excision procedure indicated for tumors invading the orbit where a conservative excision is unlikely to achieve complete clearance. However, conservative excision options such as globe-sparing orbital excisions are increasingly being considered and outcomes of this continue to emerge in the literature. Continued improvements in managing periocular skin malignancies, including techniques of margin-controlled should continue to reduce the incidence of cases presenting with orbital invasion and hence the need for orbital exenteration. [ABSTRACT FROM PUBLISHER]

Aim: To evaluate the inter-observer agreement of the Manchester Orbital Exenteration Wound Assessment Tool (MOEWAT), a tool designed to facilitate grading of healing in exenterated sockets, scores from clinical photographs of exenterated sockets. Methods: Existing MOEWAT system was modified to allow grading of clinical photographs. Photographs of 36 different patients at different stages of healing following exenteration were identified. Scores for two masked observers, who independently graded the photographs were compared. The inter-observer agreement of scores was assessed using a Bland-Altman plot, with the average agreement and 95% confidence interval around the mean computed. Results: The average age of the 36 patients was 66 ± 29 years. Photographs were taken 32 ± 16 months after exenteration. Across all photographs, the averages score given by the first observer (4.3 ± 2.2) and second observer (3.4 ± 1.5) were similar ( t = -1.9; p = 0.07). From the Bland-Altman plot, the mean difference in score (0.8 ± 1.8) was close to zero, with 95% confidence limits for agreement are indicated by the dashed lines and spanning from −2.6 to 4.3. Conclusion: MOEWAT can be successfully used to stage wound healing in exenterated sockets, with good inter-observer agreement. [ABSTRACT FROM AUTHOR]

The functional and esthetic results of reconstructive surgery after extended total maxillectomy or extended orbital exenteration greatly depend on the quality of the orbital reconstruction. We developed dynamic eye socket reconstruction using temporalis transfer to achieve good orbital reconstruction, and examined the usefulness of our technique. Five patients (three men and two women, aged 44-72 years) who underwent extensive resection of midfacial malignancies were treated with dynamic eye socket reconstruction using temporalis transfer. In most cases, eye socket reconstruction was performed approximately 1 year after the initial surgery, and temporalis transfer was used after maturation of the eye socket. The follow-up period ranged from 16 to 120 months (average 63.8 months). Movement of the upper and lower eyelids was achieved in all cases, and definite creases at the lateral canthus were observed in two patients. A good shape in the reconstructed medial and lateral canthal areas was maintained in all patients. Our reconstruction technique is extremely effective in creating natural creases ('crow's feet') at the lateral canthus during smiling, enabling movement of the upper and lower eyelids, and maintaining a sharp palpebral morphology. [ABSTRACT FROM AUTHOR]

Orbital exenteration may be needed for surgical extirpation of advanced squamous or basal carcinoma of the eye or ocular adnexa. Many surgeons prefer to allow the exenterated socket granulate by secondary intention. This leads to morbidity and can be very disturbing for the patient. Moreover, it delays the delivery of adjunctive radiation often required in these individuals. We suggest a 1-stage operation that can be undertaken at the time of exenteration or as a delayed procedure to reconstruct the orbit and ensure rapid wound healing and patient rehabilitation. There is minimal donor site morbidity. A total of 5 exenterated orbits have been reconstructed by a new technique utilizing islanded median forehead flap based upon ipsilateral supratrochlear vessels. The donor site could be closed primarily in all patients. The healing was uneventful; the median hospital stay was 3 days. Although there is inevitable scarring of the forehead, this improves considerably over a period of time and does not appear to cause undue aesthetic concerns among our patients. Thus an islandised ipsilateral paramedian forehead flap based upon supratrochlear vessels is another option to close an exenteration defect. [ABSTRACT FROM AUTHOR]

Reconstruction of the exenterated orbit remains a surgical challenge. Here, the authors present a case in which orbital exenteration was performed for an extensive, infiltrating medial canthal basal cell carcinoma; the resulting defect was reconstructed with osseointegrated implants and a pericranial flap onto which a split thickness skin graft was placed. The second stage of the aesthetic rehabilitation of this patient (placement of the transcutaneous abutments) was completed under local anaesthetic 16 weeks later. Subsequently, the patient was fitted with an oculoplastic prosthesis four weeks later. The above technique accelerates the prosthetic rehabilitation of the patient by performing the primary reconstructive procedures simultaneously with the exenteration and by removing the need for secondary surgical procedures under general anaesthetics. The whole process from orbital exenteration to the fitting of an ocular prosthesis was completed in just five months. [ABSTRACT FROM AUTHOR]

Malignant tumors of the orbit and the orbitomaxillary region constitute 4-8% of head and neck malignancies. The lesions can be primary orbital malignant tumors or can invade the orbit from the eyelids, the eyeball or the paranasal sinuses, especially the maxillary sinus and ethmoids. The commonest primary malignant tumors of the orbit are lymphomas, rhabdomyosarcomas and lacrimal gland epithelial tumors. These tumors are excluded from the present study since their management differs from that of metastatic tumors. Our experience is based on a series of 48 patients operated during the last five years. There was an equal distribution according to both age and sex, with two-thirds of the patients being over 60 years of age. Histologically, the basal cell carcinomas (B.C.C.) prevailed with 19 cases, followed by squamous cell carcinomas (Sq.C.C.) in 12, adenocarcinomas (AdenoCa) in 10 and orbital melanomas (O.M.) in 7. In 13 cases the maxilla was also affected. Surgical treatment varied from exenteration to wide cran iofacial resections; immediate reconstruction followed in all cases. Only 10 patients were treated with surgery alone. In the remaining 38 patients radiotherapy was given, alone or in combination with chemotherapy. The surgical techniques included exente ration with split-thickness skin grafting in 19 cases, exenteration with coverage with median forehead flap in 16, and maxillectomy with forehead and temporalis flaps in 7 cases. The tumors recurred in 12 patients, all of them in the first postoperative year. Ten patients died from intracranial involvement or distant metastases. In six of these patients the lesions were Sq.C.C., in two AdenoCa and in two O.M. It is concluded that the surgical treatment of orbital and orbitomaxillary malignancies, although subject to broad guidelines that determine the operability of the tumors, should be individualized according to the extent of the lesion and the experience of the surgeon. [ABSTRACT FROM AUTHOR]

Basal cell adenocarcinoma (BCAC) is a recently described rare salivary gland tumor. They are locally invasive and destructive tumors with rare incidence of metastasis. BCAC most commonly occur in the parotid gland followed by the submandibular and other minor salivary glands. The primary management of these tumors is surgery with or without adjuvant radiotherapy. Lacrimal gland is a very rare location of BCAC; only one case has been reported in English literature. We report a case of recurrent basal cell adenocarcinoma of lacrimal gland in a 75-year-old female. She had past history of local excision of a tumor in the lacrimal gland of same side 10 years back, details of which were not available with the patient. We discuss about the case and review the literature about treatment modality in basal cell adenocarcinoma. [ABSTRACT FROM AUTHOR]

Orbital exenteration is a rare radical procedure used for the treatment of locally invasive or potentially life threatening orbital tumors. The procedure results in significant visual and psychosocial disability. Recently there has been a shift toward a subtotal extenteration with maximum preservation of orbital tissue and globe in appropriate cases. We describe the management dilemma of a patient with orbital extension of a frontal sinus squamous cell carcinoma. The patient underwent combined craniofacial and transnasal macroscopic excision with globe preservation. Traditional approach for a sinus tumor that has invaded the orbit would be an exenteration. The favorable outcome of the case reported here raises the possibility of considering this approach more frequently. [ABSTRACT FROM AUTHOR]