Surgical management of the anophthalmic orbit, part 2: Post-tumoral

Ablative surgery for tumors of the globe and its adnexal structures is freq uently the cause of major orbitofacial deformity. Radiotherapy compounds th e problem because it suppresses skeletal growth in the growing patient and induces a contraction of the remaining soft tissues in the orbit. Goals for reconstruction in these patients include the restoration of orbital struct ures to allow the fitting of an ocular prosthesis and the correction of dis torted orbitofacial relationships. The authors present a series of 53 patie nts (mean age, 29 years; 28 male) who were treated over the past 18 years b y composite reconstruction of the post-tumoral anophthalmic orbit. The foll ow-up ranged from 5 months to 18 years (mean, 7.75 years). Four patients we re treated primarily (immediate reconstruction after tumor ablation), and 4 9 were treated secondarily (mean oncological follow-up since ablative surge ry, 14.8 years). Twenty-eight patients underwent orbital enucleation (inclu ding three bilateral cases), 23 underwent orbital exenteration, and two und erwent evisceration. Forty-two patients received radiotherapy, including 20 enucleation patients, 15 exenteration patients, and seven others in whom d etails of primary therapy were incomplete. A staged reconstruction was unde rtaken in each case; it considered, in turn, the bony orbital volume (orbit al remodeling and cranial bone grafts), orbital contents (implant, temporal is muscle transposition, cranial bone grafts, and dermafat grafts), conjunc tival sac (mucosal and skin grafts), ocular prosthesis, eyelids (local flap s and skin grafts), and additional procedures to restore orbitofacial symme try. The authors conclude that the long-term results of post-tumoral orbita l reconstruction are favorable, and they particularly recommend the use of autogenous tissues in irradiated orbits.