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Reconstruction of orbital exenteration defects by primary closure using cheek advancement
  1. Mano Sira,
  2. Raman Malhotra
  1. Corneo-Plastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, UK
  1. Correspondence to Raman Malhotra, Corneoplastic Unit, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK; raman{at}ramanmalhotra.com

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.

  • Orbit
  • Neoplasia
  • Treatment Surgery
  • Rehabilitation

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