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Surgical Management of Tumors Involving the Orbit

Noam Weizman, MD1; Gilad Horowitz, MD1; Ziv Gil, MD, PhD1; Dan M. Fliss, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
JAMA Otolaryngol Head Neck Surg. 2013;139(8):841-846. doi:10.1001/jamaoto.2013.3878.
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Importance  Surgical treatment of orbital tumors is a complex task that requires thorough preparation and precise planning. Since a large variety of tumors of different origins, anatomical extents, and histologic subtypes affect the globe, no “1-size-fits-all” approach can be offered.

Objective  To describe an integrative approach for the optimal surgical management of patients with orbital tumors based on a review of the literature and on our own experience at a high-volume cancer center.

Evidence Review  Peer-reviewed English-language literature and a single-center cohort of patients undergoing orbital exenteration with eye sparing, reconstruction, and preservation of orbital function.

Findings  Surgical treatment of orbital tumors is a complex task that requires thorough preparation and precise planning that would be aided by an algorithm.

Conclusions and Relevance  We offer an algorithm that summarizes our approach toward the 2 main decision points of orbital surgery: extent of resection and method of reconstruction.

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Figures

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Figure 1.
Therapeutic Algorithm

The extent of orbital resection is determined following preoperative and intraoperative evaluation of orbital involvement. CT indicates computed tomographic scan; MRI, magnetic resonance imaging.

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Figure 2.
A Large Facial Defect Following Resection of an Osteosarcoma Reconstructed With a Rectus Abdominis Free Flap and Calvarial Bone Grafts for the Nasal Bones

A, Intraoperative view. B, Immediately postoperative view.

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Figure 3.
Reconstructive Algorithm for Orbital Exenteration Defects

ALT indicates anterolateral thigh graft; PTSG, partial thickness skin graft; TP temporoparietal.

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Figure 4.
Reconstruction of the Orbital Floor With Titanium Mesh Following Resection of an Undifferentiated Carcinoma of the Maxillary Sinus

The inner surface of the mesh was covered with temporoparietal fascia.

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Figures 5.
Titanium mesh covered with temporoparietal fascia and a skin graft were used to reconstruct a lateral composite orbital wall defect.

A, Titanium mesh plainly visible before temporoparietal fascia is pulled into place. B, Temporoparietal fascia being pulled into place.

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Figure 6.
Titanium Mesh Reconstruction of Both Orbital Roofs and Medial Orbital Walls

Centripetal compression of the medial canthi was used in the reconstruction following subcranial surgery for resection of an anterior skull-base rhabdomyosarcoma.

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Figure 7.
Reconstructive Algorithm for Partial Orbital Resection Defects

TP indicates temporoparietal fascia.

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