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Orbital exenteration for secondary orbital tumors: a series of seven cases.

BACKGROUND
Exenteration is indicated in patients with malignant neoplasms of orbital contents. It entails the removal of the eyeball together with its extraocular muscles and other soft tissues. Exenterations can be classified into (1) total, (2) subtotal, and (3) supertotal exenteration. Retrospectively study, we reviewed 7 patients that had received exenteration/subtotal exenteration with spontaneous granulation/myocutaneous flap implantation or eyelid-sparing exenteration with myocutaneous flap. Primary lesions, histopathological examination results, treatments, and recurrences are discussed.


METHODS
A retrospective study of the years 1987 through 2000 disclosed 7 patients that underwent exenteration/subtotal exenteration. The patients ranged in age from 41 to 68 years. Two patients underwent total exenteration without socket augmentation; 4 patients underwent exenteration/ subtotal exenteration with immediate facial reconstruction, and 1 with delayed facial reconstruction.


RESULTS
Classification of the 7 patients showed that 2 had basal cell carcinoma of the skin, 2 had squamous cell carcinoma of the conjunctiva, 1 had squamous cell carcinoma of the paranasal sinus, 1 had rhabdomyosarcoma of the paranasal sinus, and 1 had intracranial meningioma. Radiotherapy was performed in 6 of the patients and chemotherapy in 2. Central nerve system invasion was noted in 2 patients, and 1 died due to it.


CONCLUSION
Secondary orbital tumors involved the orbit from adjacent tissues: paranasal sinuses, nasopharynx, lacrimal sac, conjunctiva, eyelid, intraocular tissue, and intracranial tissues. Combined surgeries are necessary for complete tumor removal. And the imaging studies should include the field of the orbit, sinus, and brain to search for the primary lesions.