The possibility to perform an eyelid-sparing orbital exenteration
and the surgical resection of the neoplasm with immediate reconstruction using a temporal muscle flap was valued; a function-sparing intervention was planned after the histopathological analysis and the confirmation of an aggressive and rapid course of the disease.
Whenever dura resection and reconstruction are associated with orbital exenteration
, primary coverage of the orbit is critical for protection against meningitis .
An 81-year-old man with hemangiopericytoma had clinically conspicuous manifestation of a first slowly then rapidly growing, painless, and sublobe-like mass in the left orbit, proptosis, massive bleeding, and underwent orbital exenteration
with keeping the eyelids.
(3) For example, in the 6th edition, an eyelid carcinoma with bulbar conjunctival extension, which was amenable to globe-preserving surgical resection, fell into the same T4 category as a tumor with deep orbital invasion that would be amenable only to orbital exenteration
. A nonresectable tumor with deep central nervous system invasion would also be a T4 in the 6th edition classification.
Of the five primary orbital ES cases reported, two patients were treated with orbital exenteration
, two were treated with surgical debulking followed by chemotherapy [6, 7], and one was treated with surgical excision followed by local radiation therapy .
Because of the tumor's proximity to the orbit, the patient opted for chemotherapy prior to surgical intervention in an attempt to avoid orbital exenteration
Subsequently, the patient underwent a maxillectomy with orbital exenteration
. The tumor measured 3.5 cm in greatest dimension and focally extended to the outer aspect of the eye; however, the uveal tract (choroid and ciliary body) was not involved, and there was no tumor mass inside the globe.
Finally, enucleation or orbital exenteration
is generally reserved for larger tumors that are unresponsive to other therapeutic modalities.
They range from the simple to the complex--debridement of the necrotic mucosa; Caldwell-Luc surgery; medial maxillectomy, ethmoidectomy, and sphenoidotomy; and radical maxillectomy with orbital exenteration
. Both endoscopic and open approaches have been described, in both single and multiple stages.
The patient underwent radical maxillectomy with orbital exenteration
and radical neck dissection.
Of the 30 patients who had surgery, 26 underwent procedures that included maxillectomy, six underwent orbital exenteration
, and three underwent craniofacial resection.