Reconstruction of orbital exenteration defects by primary closure using cheek advancement. Issue 2 (4th December 2012)

• Record Type: Journal Article
• Authors: Sira, Mano; Malhotra, Raman
• Is Part Of: British journal of ophthalmology. Volume 97:Issue 2(2013)
• Page Start: 201
• Page End: 205
• Publication Date: 2012-12-04
• Subjects: Orbit -- Neoplasia -- Treatment Surgery -- Rehabilitation; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2012-301600
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Introduction: Orbital exenteration is a highly disfiguring procedure which, although providing local control of invasive orbital malignancy also results in marked visual, psychological and social disability. We present three consecutive total exenteration cases over 1 year where all 3, including extended exenteration defects, were repaired by primary closure by way of cheek advancement. This technique may be considered where succinct management with minimal follow-up is required and maybe preferable if considering rapidity of rehabilitation with a short time to fitting definitive prostheses. Methods: Retrospective review of three consecutive patients who presented with neglected basal cell carcinoma with orbital invasion and subsequently underwent total orbital exenteration with repair by cheek advancement flap. Results: All underwent repair with primary skin closure using a cheek advancement flap. Patient 2 developed a small area of central flap dehiscence noted at 2 months with almost complete granulation of the orbital cavity at 3 months. Patients 1, 2 and 3 were fitted with final prosthesis at 7, 6 and 12 months, respectively. Conclusions: Reconstruction of the exenterated orbit using cheek advancement represents an evolution of the cervico-facial flap repair. The cheek advancement avoids creating a secondary defect and because it involves less dissection and additional skin incisions, is an easier procedure to perform with fewer facial scars. It does not preclude osseointegration if required at a later date and as such we recommend it as an option in repairing the exenterated orbit.