Abstract
Background Orbital reconstruction following oncologic midface resection is uniquely challenging,
and makes critical contributions to patient aesthetics, function, and identity. Approach
is largely dependent on surgeon and patient preferences, and there exists no consensus
on defect characterization.
Objective The goal of the study is to provide a mental framework for the reconstructive oncologic
surgeon to use as a foundation during his or her approach to the orbit.
Design The design of the study is based on the review of current literature and expert opinion.
Conclusions Critical versus optimal objectives must be set in orbital reconstruction, and a systematic
approach should be followed. We approach orbital reconstruction by first deciding
whether globe-sparing surgery is possible, or if orbital exenteration will be necessary.
We then set critical and optimal objectives for our chosen pathway. Critical goals
in globe-sparing reconstruction include maintaining orbital volume and preserving
visual function, and an optimal goal includes preservation of the nasolacrimal system.
Critical goals in orbital exenteration include obliterating the defect, sealing the
skull base and nasal cavities, and allowing eye protection to be worn over the contralateral
eye postoperatively. Optimal goals in exenteration include preparation for prosthetics,
volume and bony replacement, eyelid-sparing technique, and consideration of postoperative
radiation.
Keywords
orbit - globe - reconstruction - midface - exenteration - flap - approach - planning
