Orbital exenteration for invasive skin tumours

Area of Science:

• Ophthalmology
• Surgical Oncology
• Head and Neck Cancer

Background:

• Orbital exenteration is a radical surgical procedure for managing potentially fatal or relentlessly progressive orbital diseases.
• Tumors of the eyelid and periocular skin, predominantly basal cell carcinomas, account for 40-50% of exenterations.
• Orbital invasion by tumors leads to fixation, reduced motility, and potential nerve involvement (trigeminal and facial).

Purpose of the Study:

• To review the indications, surgical techniques, outcomes, and complications associated with orbital exenteration for managing orbital tumors.
• To highlight the importance of multidisciplinary management involving oncologists and ophthalmologists.
• To discuss reconstructive options and long-term functional and cosmetic results.

Main Methods:

• Review of clinical data and outcomes for patients undergoing orbital exenteration.
• Diagnostic modalities including biopsy, CT, and MRI for tumor assessment.
• Surgical techniques: total exenteration versus lid-sparing approaches.
• Reconstruction methods: healing by granulation, skin grafts, or local flaps.

Main Results:

• Complications occur in 20-25% of cases, including fistulae, necrosis, exposed bone, and infection.
• Incomplete tumor clearance rates are higher in total exenterations (38%) compared to subtotal (17%).
• Overall 5-year survival is 55-65%, significantly reduced with perineural spread.

Conclusions:

• Orbital exenteration is a critical intervention for advanced orbital tumors, offering local disease control.
• Careful patient selection, accurate staging, and meticulous surgical technique are essential to minimize complications and maximize oncologic outcomes.
• Reconstruction and prosthetic rehabilitation can achieve satisfactory functional and cosmetic results, though patient preference for patching exists.