Pedicled Lateral Orbitotomy Approach for the Excision of Intraorbital Tumors: Our Experience

Introduction: Several approaches to the intraorbital space occupying lesions have been described in the literature. Selection of a proper approach to intraorbital lesions depends on various factors including the location of the tumor, size of the lesion, and the probable pathology anticipated. Access to retrobulbar tumors is highly demanding and challenging which usually requires lateral orbitotomy approach to provide good access.

Aim: To review the modified technique of lateral orbitotomy and assess the outcome of surgery in the management of intraorbital tumors.

Methods: The data of patients with intraorbital tumors, who were operated using the modified (pedicled) technique of lateral orbitotomy in past 5 years from January 2020, were collected retrospectively. The data was collected for the defined parameters like demographic details, diagnosis, size, location of tumor, fixation method used, complications and survival.

Results: A total of three patients were operated using this technique with mean age of 43 years. All patients were females and diagnosed with benign tumor in post operative histopathological reporting. Two patients had cavernous hemangioma and one was a case of pleomorphic adenoma lacrimal gland. These cases were operated by multidisciplinary team consisting of ophthalmologist and maxillofacial surgeons. A modified (pedicled) lateral orbitotomy approach was used to excise the tumor. In all cases the exposure was adequate to excise the tumor and reconstruction was done by fixing the osteotomized orbital wall with titanium microplates. All patients recovered well with good esthetic outcome. All patients had improvement in visual acuity in post operative phase as compared with preoperative readings. No major complication was seen in any of the cases. All patients had a mean follow-up of 32.7 months. All patients survived till the last follow-up without any recurrence. On postoperative X-rays, there was no resorption of osteotomized bone and fixation was stable.[1] [2] [3] [4]

Conclusion: Pedicled lateral orbitotomy is an effective approach for surgical excision of intraorbital tumors with minimal morbidity and good aesthetic outcome. Also, there is advantage of avoiding complications like resorption and infection of the osteotomized fragment due to the maintenance of vascularity by pedicled bone flap ([Figs. 1] [2] [3] [4]).

Fig. 1 Contrast-enhanced CT image (axial section) of patient no. 3 showing lacrimal gland tumor occupying the intraorbital space leading to proptosis of left eyeball.

Fig. 2 MR T2-weighted image (sagittal section) of patient no. 3 showing intraorbital space occupying tumor and abutting the brain at superior orbital wall region.

Fig. 3 Postoperative frontal view of patient no. 3 showing symmetrical position of orbits and eyeballs with aesthetic facial outcome.

Fig. 4 Postoperative X-ray (PA view skull) of patient no. 3 showing an adequate and stable fixation of osteotomized fragment.

Publikationsverlauf

Artikel online veröffentlicht:
01. Februar 2023

• References

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