A Novel Preliminary Step in Orbital Exenteration

Abstract

Objective: An external approach of orbital exenteration involves retracting the orbital contents within a nonexpandable bony orbit. Orbital pressure would be more raised for patients with orbital tumors where retraction of the orbital contents may be difficult. We describe a simple preliminary step, which may be used to facilitate orbital retraction. Method: Case reports at a university teaching hospital for nasal tumors with orbital involvement. For the literature research, MEDLINE search from 1950 to Jan 2012. Results: Prior to orbital exenteration, the cornea of the affected eye is aspirated with a 21-gauge needle. Approximately 3 to 4 mL of clear fluid can be aspirated. This subsequently causes depression of the bulbar conjunctiva and globe, which reduces the intraocular pressure. This allows orbital contents to be easily retracted and facilitates easy division of the orbital muscles as well as aiding the control of bleeding from the orbital apex, under direct vision. This technique has not previously been reported in the literature. We have used this technique in 18 cases of orbital exenteration for maxillary tumors with orbital involvement. Conclusion: We have used this technique without any subsequent complications and found it to be extremely useful particularly as it enhances visualization of the orbital apearea. This preliminary step explained above can be an adjunct to all methods of orbital exenteration.