China
Africa
Explore chapters and articles related to this topic
Adult Ocular and Orbital (Ocular Adnexa) Tumors
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
P.N. Plowman, Rachel Lewis, J.L. Hungerford
Because of their poor outlook, melanomas arising in the eyelid, conjunctival fornix, and, particularly, caruncle have all been traditionally managed by orbital exenteration. The role of exenteration was compared retrospectively in two groups of patients, one of which underwent the operation as the primary treatment of their disease and the other first underwent conservative treatment, with exenteration being reserved for palliative treatment.30 The second group of patients was not seen to be disadvantaged by prior conservative surgery in terms of survival. The key to survival appeared to be the thickness of the largest tumor rather than the treatment method, with overall melanoma-related mortality ranging between nil in tumors with a maximum thickness of 1 mm and 50% in those in excess of 2-mm thickness. A particularly poor outcome was noted for caruncular melanoma, with six out of seven patients dying despite primary exenteration. These results had suggested that, where possible, a conservative approach should be tried first.
Sinonasal tumours
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Yujay Ramakrishnan, Shahzada Ahmed
Orbital clearance/exenteration also needs to be considered pre-emptively in cases where the orbit is going to receive radiotherapy (either directly or within the margins of the primary treatment area). Radiotherapy causes blindness through retinopathy/optic neuropathy, causes disabling and irreversible diplopia through fibrosis of the extraocular muscles, and can cause crippling pain. As a result, many patients may be better off having clearance/exenteration performed.
The rectum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The aim is to remove pelvic organs involved in the malignant process, and may involve a partial exenteration (posterior exenteration, including rectum and posterior vagina/ uterus) or complete (including rectum and urogenital organs) (Figure73.23). Exenteration may be necessary for advanced local disease, but more commonly for disease recurrence. It involves a large excision of the pelvic floor, leaving a sizeable perineal defect that has to be reconstructed using a plastic surgical procedure. Rectus abdominus or gluteal flaps can be used to fill the empty pelvis. Special care must be taken to suture the perineal skin accurately, and to avoid pressure necrosis by nursing the patient on alternate sides. Excision of the bladder will require the formation of an ileal conduit in addition to a colostomy.
Psychosocial factors among patients undergoing orbital exenteration
Published in Clinical and Experimental Optometry, 2023
Neelima Balakrishnan, Sahil Agrawal, Rachna Bhargava, Veena Jain, Neelam Pushker, Rachna Meel, Mandeep S. Bajaj
The human face establishes the identity of a person in society. Its normalcy is an important factor for self-confidence, communication, developing interpersonal relationships and for overall well-being. Exenteration is a procedure that involves removal of contents of the orbit including appendages. It is mostly done in locally advanced malignancies that are not amenable to any other treatment as a life-saving procedure as seen in the present study also.3,4 There are several reports on psychosocial challenges associated with the cancer patients.5,6 Facial disfigurement related to destructive surgeries such as enucleation, evisceration and exenteration, adds on to the trauma due to associated social stigma leading to a functional, social, personal and financial setback.1,7 Though there are several reports available on the psychosocial issues in one-eyed patients, patients who underwent evisceration, enucleation, or had disfigurement due to facial trauma but the literature is scarce on the psychosocial impact and quality of life in patients who underwent exenteration.7 Furthermore, to the best of the knowledge, there is no prospective comparative study on pre-operative and post-operative changes in severity of psychosocial issues, quality of life and its difference with the patients wearing prosthesis post-exenteration.
A case of mistaken identity: Saksenaea vasiformis of the orbit
Published in Orbit, 2021
Allison J. Chen, Lilangi S. Ediriwickrema, Rohan Verma, Vera Vavinskaya, Solomon Shaftel, Adam S. Deconde, Bobby S. Korn, Don O. Kikkawa, Catherine Y. Liu
The universal agreement for management of invasive fungal sinusitis includes (1) treatment with systemic antifungals, (2) debridement of necrotic tissue, (3) reduction in immune suppression, and (4) correction of metabolic derangement when feasible. The current landscape of orbital management of disease is evolving between the spectrum of exenteration and globe-sparing surgery (e.g. functional endoscopic sinus surgery) in unity with periorbital injections of amphotericin. The largest review to date on exenteration studied 807 patients who failed to demonstrate an improvement in patient survival.8 The past decade, as a result, has led to a shift towards conservative debridement with local irrigation of orbital tissue, and more recently, with off-label peribulbar injection of AmB ranging from daily to weekly treatments with reported excellent postoperative visual acuity.9–15 These injections can be done at bedside, typically do not require general anesthesia, and are less invasive than the other options. Potential disadvantages include the possibility of transient moderate to severe orbital inflammation due to the intrinsic inflammatory properties of amphotericin as well as the reported potential for local cytotoxicity in vitro.16,17 The former is more likely to occur with AmB formulated with deoxycholate that is dose-limited systemically by acute infusion-related reactions and nephrotoxicity. Inflammation occurs less frequently with L-AmB given its smaller size and composition can avoid substantial immune recognition.17,18
Orbital exenteration and reconstruction in a tertiary UK institution: a 5-year experience
Published in Orbit, 2021
J. C. Fleming, I. Morley, M. Malik, G. Orfaniotis, C. Daniel, W. A. Townley, J. P. Jeannon
Pre-operative imaging was standardized to include as a minimum CT imaging and MRI imaging of the orbits within one month of surgery, allowing accurate restaging of both bony and soft tissue involvement, respectively, at tumor board review. All exenteration procedures were performed under the care of the senior authors. Surgical technique included eyelid sparing incisions where feasible but the presence of scars and previous surgery, together with the availability of free flap reconstruction, commonly resulted in eyelid sacrificing incisions at the orbital rim. Circumferential periobita incisions were made, keeping any medial attachments intact where en bloc resection including old scar tissue or medial maxillectomy/lateral rhinotomy were to be performed. Orbital dissection proceeded along the roof and lateral orbital walls, with hemostasis by surgical clips/bipolar cautery at the superior orbital fissure. The optic nerve and ophthalmic artery were controlled in a similar fashion; suture ligation and judicious use of fibrin sealant at the orbital apex was performed routinely to prevent any CSF leak. Osteotomies were performed utilizing a piezoelectric system (DePuy Synthes [Johnson & Johnson], PA, USA), with bony cuts modified to complete an oncologically sound resection margin.