Entire Orbital Contents Research Articles

Dermis fat graft for pediatric exenteration-challenging but rewarding

Orbital exenteration is a destructive and disfiguring surgery and involves removal of the entire orbital contents, soft tissue and often lids as well. We report a case of an eight month old female, with malignant orbital teratoma who underwent lid sparing exenteration for the destructive, locally advanced disease. Three month post surgery she developed recurrence with intracranial extension as well as socket infection with pus discharge. Repeat surgery involved a multispeciality approach for removal of the tumor which was abutting the cavernous sinus posteriorly and ethmoid sinus medially, apart from filling the entire bony orbit. The focus of infection was found to be the retained lacrimal sac. The unhealthy lid skin also had to be sacrificed. The challenges in repeat exenteration of an 8month old, and the utility of autologous dermis fat graft as a reconstructive option are discussed.

A novel flexible microfluidic meshwork to reduce fibrosis in glaucoma surgery.

Purpose/RelevanceFibrosis and hence capsule formation around the glaucoma implants are the main reasons for glaucoma implant failure. To address these issues, we designed a microfluidic meshwork and tested its biocompatibility in a rabbit eye model. The amount of fibrosis elicited by the microfluidic meshwork was compared to the amount elicited by the plate of conventional glaucoma drainage device.MethodsSix eyes from 3 New Zealand albino rabbits were randomized to receive either the novel microfluidic meshwork or a plate of Ahmed glaucoma valve model PF7 (AGV PF7). The flexible microfluidic implant was made from negative photoresist SU-8 by using micro-fabrication techniques. The overall size of the meshwork was 7 mm × 7 mm with a grid period of 100 μm. Both implants were placed in the subtenon space at the supratemporal quadrant in a standard fashion. There was no communication between the implants and the anterior chamber via a tube. All animal eyes were examined for signs of infection and implant erosion on days 1, 3, 7, and 14 and then monthly. Exenterations were performed in which the entire orbital contents were removed at 3 months. Histology slides of the implant and the surrounding tissues were prepared and stained with hematoxylin-eosin. Thickness of the fibrous capsules beneath the implants were measured and compared with paired student’s t-test between the two groups.ResultsThe gross histological sections showed that nearly no capsule formed around the microfluidic meshwork in contrast to the thick capsule formed around the plate of AGV PF7. Thickness of the fibrotic capsules beneath the AGV PF7 plate from the 3 rabbit eyes was 90μm, 82μm, and 95 μm, respectively. The thickness at the bottom of fibrotic capsules around the new microfluidic implant were 1μm, 2μm, and 1μm, respectively. The difference in thickness of capsule between the two groups was significant (P = 0.002). No complications were noticed in the 6 eyes, and both implants were tolerated well by all rabbits.ConclusionThe microfluidic meshwork elicited minimal fibrosis and capsule formation after 3-months implantation in a rabbit model. This provides promising evidence to aid in future development of a new glaucoma drainage implant that will elicit minimal scar formation and provide better long-term surgical outcomes.

A Simplified Method to Fabricate a Pneumatic Ocular Prosthesis for Large Ocular Defects.

When an enucleation or exenteration procedure removes the entire orbital contents but not the eyelids, an abnormally large orbital socket is created that would require an equally sized volume enhancing, flush fitting ocular prosthesis. The solid acrylic prosthesis would rest on or in the lower fornix and owing to its weight, causes distortion of the lower eyelid and/or asymmetrical alignment of the entire palpebral fissure. The aim of this article was to describe a method of fabricating a pneumatic light weight custom ocular prosthesis using lost wax technique to overcome the deteriorating effects of conventional solid ocular prosthesis.

Martwicze zapalenie tkanek twarzoczaszki (tzw. rak wodny)

Cancrum oris is a devastating opportunistic infection which destroys the tissues of the face. The risk factors are poverty, malnutrition, poor oral hygiene, diabetes, recent illness, alcohol abuse and smoking, low birth weight, Acquired Immune Deficiency Syndrome or other conditions with impaired immune system. Without appropriate treatment, the mortality rate from noma is 70–90% especially among children. It evolves from a necrotizing gingivostomatitis to widespread orofacial gangrene causing grotesque deformation. This is very rare but serious condition occurring mostly in Africa but single cases were reported worldwide. After healing the stadium of inflammation the patient require multiple reconstructive surgery. Microbiological etiology depends on area where patient got infected but mostly involves Fusobacterium necrophorum, Pseudomonas aeruginosa, Prevotella intermedia and Staphylococcus spp. The 32-year-old male was admitted to Internal Medicine Department in very bad condition, unconscious, feverish, in diabetic coma. After stabilization he was transferred to ENT Department in order to treat widespread inflammation of the face. In differential diagnostic procedure conditions such as cancer, Wegener syndrome, AIDS, actinomycosis and mycosis were excluded. Examination of culture showed growth of Pseudomonas aeruginosa, Escherichia coli and Proteus mirabilis. Despite of intensive treatment the inflammatory infiltration spreaded. The CT scans showed advanced inflammatory process in temporal region, cheek, eyelids, optic nerve, extraocular muscles and orbital cavity. The removal of the entire orbital contents was decided and proceeded together with ophthalmologists. After widespread surgical treatment of the orbital, sphenoidal, temporal, nasal, ethmoidal and maxillar region the inflammation was cured.

Orbital Exenteration: Results of an Individualized Approach

The authors report and evaluate their experience with an individualized approach to orbital exenteration. Retrospective chart review was performed on a consecutive series of 25 orbital exenteration patients at a tertiary care center. The cases were classified into two groups for the retrospective analysis: Total exenteration procedures involved the removal of the entire orbital contents including the periorbita (13 cases), and subtotal procedures preserved at least a quadrant of the orbit or the orbital tissues posterior to the globe (12 cases). The total exenteration group had a lower rate of clear surgical margins and a higher rate of systemic metastasis, whereas patients in the subtotal exenteration group had fewer surgical complications and better functional and aesthetic results. The surgical planning for orbital exenteration should take into account the location, extent, and biological behavior of the orbital disease process and the reconstructive and prosthetic options for the exenterated socket. When an individualized approach to orbital exenteration is used, subtotal procedures can offer improved functional and aesthetic results while still maximizing the chances for a surgical cure.

Evisceration, Enucleation, and Exenteration

The removal of the intraocular contents, the globe itself, or the entire orbital contents are three procedures that each present distinct pre- and postoperative problems. These procedures and the management challenges they present are discussed in this article.

Basal cell carcinoma of the medial canthal area.

We advise an aggressive approach in ablating basal cell carcinomas which have originated in the region of the medial canthus. Extirpation of the entire tumor under accurate histological control, whether it includes skin only or the entire orbital contents and ethmoid air cells--and reconstruction with one of the described procedures--gives the surgeon an effective armamentarium to successfully treat these potentially lethal lesions.

PROSTHESES FOR THE EYE AND ORBIT

After destruction of the eye, a glass eye is sufficient prosthesis unless the eyelids are also missing. Patients who require only a glass eye do not present themselves at the prosthetic laboratory. Most commonly a prosthesis is required after surgical exenteration of the entire orbital contents. The patient is confronted with a number of choices : ( a ) to flaunt the defect, walking about with it visible and making no effort to conceal it ; ( b ) to hide the defect with a bandage, and ( c ) to substitute a prosthesis for the lost organ or portion of an organ. A prosthesis for the orbit should not be made until the skin of the area is adequately healed, unless provision is made on the under surface of the prosthesis for protection of any raw or granulating areas. Figure 1 shows a 20 year old woman who had had exenteration of the entire orbital contents for

The Mechanism of Experimental Exophthalmos

The experimental observations were confined to the dog. In this animal the entire orbital contents, with the exception of the lacrimal gland, are enclosed in a conical fascial sheath. The base of the cone surrounds the orbital margins in front and its apex is attached to the foramina at the posterior of the orbit. The superior surface of the sheath is composed of alternating layers of elastic and connective tissue, directly continuous with which are strands of smooth-muscle fibers. Electrical stimulation of the cephalic end of the cut vagosympathetic trunk causes a circular contraction of the cone-shaped sheath, squeezing the eye forward into the position seen in exophthalmos. The action and independent contraction of the sheath have been carefully established. The importance of the conical sheath is illustrated by the fact that the surgical removal of a strip of the sheath establishes a chronic enophthalmos. From the Department of Physiology and the Division of Experimental Medicine, The Mayo Foundation. Submitted for publication July 15, 1935.