Periorbital and orbital malignancies: methods of management and reconstruction in Iraq

Orbital cancer is rare, and in this study, few cases are reported consisted of 16 patients (nine female, seven male). Age ranged from 9 months to 75 years. Tumor types were squamous cell carcinoma, basal cell carcinoma, conjunctival squamous cell carcinoma, retinoblastoma, fibrosarcoma, and ectopic mixed tumor in two, one, two, one, one, and one patients, respectively, in addition to eight patients with jaw lymphoma involving the orbit, out of 24 patients reported by us. Eight patients were treated surgically with adjuvant postoperative radiotherapy, whereas eight patients with lymphoma treated with combination chemotherapy (vincristine, Adriamycin, cyclophosphamide, methotrexate, and prednisolone), the survival rate was very poor. Follow up ranged from 1 to 5 years. Surgery consisted of complete excision of orbital content (exenteration) with or without partial orbitectomy in four patients and wide excision of the tumor in four patients. Reconstruction of the defect was accomplished using various local skin flaps and temporalis muscle flap was used for augmenting the orbit in the four exenterated patients. No complications were encountered. Survival rate was quite good except for patients with lymphoma with 91.9% mortality. There is no single best method for reconstruction of the periorbital and orbital defects left after tumor resection, and different flaps applied for reconstruction had given satisfactory results related to the type and complexity of the deformity. Temporalis muscle flap in this study had proved to be versatile and highly reliable flap in terms of bulk and vascularity for blocking the orbit. The aim of this study was to show our experience in the management of these cases with minimum surgical morbidity and deformity.