orbital exenteration
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Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 94
Author(s):  
Paolo Palmisciano ◽  
Gianluca Ferini ◽  
Christian Ogasawara ◽  
Waseem Wahood ◽  
Othman Bin Alamer ◽  
...  

Background: Orbital metastases often lead to severe functional impairment. The role of resection, orbital exenteration, and complementary treatments is still debated. We systematically reviewed the literature on orbital metastases. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched upon PRISMA guidelines to identify studies on orbital metastases. Clinical characteristics, management strategies, and survival were analyzed. Results: We included 262 studies comprising 873 patients. Median age was 59 years. The most frequent primary tumors were breast (36.3%), melanoma (10.1%), and prostate (8.5%) cancers, with median time interval of 12 months (range, 0–420). The most common symptoms were proptosis (52.3%) and relative-afferent-pupillary-defect (38.7%). Most metastases showed a diffuse location within the orbit (19%), with preferential infiltration of orbital soft tissues (40.2%). In 47 cases (5.4%), tumors extended intracranially. Incisional biopsy (63.7%) was preferred over fine-needle aspiration (10.2%), with partial resection (16.6%) preferred over complete (9.5%). Orbital exenteration was pursued in 26 patients (3%). A total of 305 patients (39.4%) received chemotherapy, and 506 (58%) received orbital radiotherapy. Post-treatment symptom improvement was significantly superior after resection (p = 0.005) and orbital radiotherapy (p = 0.032). Mean follow-up was 14.3 months, and median overall survival was 6 months. Fifteen cases (1.7%) demonstrated recurrence with median local control of six months. Overall survival was statistically increased in patients with breast cancer (p < 0.001) and in patients undergoing resection (p = 0.024) but was not correlated with orbital location (p = 0.174), intracranial extension (p = 0.073), biopsy approach (p = 0.344), extent-of-resection (p = 0.429), or orbital exenteration (p = 0.153). Conclusions: Orbital metastases severely impair patient quality of life. Surgical resection safely provides symptom and survival benefit compared to biopsy, while orbital radiotherapy significantly improves symptoms compared to not receiving radiotherapy.


Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5691
Author(s):  
Sacha Nahon-Estève ◽  
Corine Bertolotto ◽  
Alexandra Picard-Gauci ◽  
Lauris Gastaud ◽  
Stéphanie Baillif ◽  
...  

Although its incidence has increased over the last decades, conjunctival melanoma (CM) remains a rare but challenging periocular malignancy. While there is currently no recognized standard of care, “no-touch” surgical excision followed by adjuvant treatments is usually recommended. Despite its small size, managing CM is challenging for clinicians. The first challenge is the high risk of tumour local recurrence that occurs in about one third of the patients. The management of locally advanced CM (≥T2) or multiple recurrences may require mutilating surgeries such as orbital exenteration (OE). The second challenge is the metastatic spread of CM that occurs in about one quarter of patients, regardless of whether complete surgical excision is performed or not. This highlights the infiltrative and highly aggressive behaviour of CM. Recently, attention has been directed towards the use of eye-sparing strategies to avoid OE. Initially, wide conservative surgeries followed by customized brachytherapy or radiotherapy have appeared as viable strategies. Nowadays, new biological insights into CM have revealed similarities with cutaneous melanoma. These new findings have allowed clinicians to reconsider the management of locally advanced CM with “medical” eye-sparing treatment as well as the management of metastatic spread. The aim of this review was to summarize the current and future perspectives of treatment for CM based on recent biological findings.


2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Ozge Dereli ◽  
Cengiz Sahutoglu ◽  
Taner Balcioglu

Abstract Background In patients who have undergone head and neck surgery and received radiotherapy, airway management presents serious difficulties for the anesthesiologist. Case presentation We report a case of a 23-year-old male patient undergoing an emergency operation due to a rhabdomyosarcoma pressed spinal cord that loss of muscle strength and loss of sensation developed below the level of thoracal 6–7 vertebrae. Because of the previous radiotherapy reducing the mouth opening (less than 1 cm), the patient was intubated by transorbital pathway without any difficulty. Conclusions Transorbital intubation seems to be a safe method and may be a good alternative to difficult airway in the patient undergoing orbital exenteration.


Author(s):  
Mario Turri-Zanoni ◽  
Alberto Daniele Arosio ◽  
Edoardo Agosti ◽  
Paolo Battaglia ◽  
Mario Cherubino ◽  
...  

2021 ◽  
Vol 62 (10) ◽  
pp. 1333-1339
Author(s):  
Woo Young Son ◽  
Na Ri Park ◽  
Sung Eun Kim ◽  
Suk-Woo Yang

Purpose: We report the clinical outcomes of Korean patients who were diagnosed with orbital malignancies and underwent orbital exenteration.Methods: We retrospectively reviewed the tumor origins, histopathological diagnoses, local/regional recurrences, distant metastases, surgical margin clearances, overall and event-free survivals, and adjuvant chemotherapy or radiation therapy statuses of 14 patients who underwent orbital exenteration in our center from February 2009 to March 2020.Results: We enrolled seven men and seven women of mean age at the time of exenteration of 68 years (range, 37 to 80 years). The mean follow-up period was 44.6 months (range, 10 to 133 months). Most tumors had arisen in the eyelid (seven cases, 50.0%). The most common pathological diagnosis was malignant melanoma (five cases, 35.7%). We observed no local or regional recurrence after exenteration, but distant metastases developed in seven cases, of which four were malignant melanomas (80% of all melanomas). Positive surgical margins were observed in six cases (42.9%). The distant metastasis rate was 42.9%; the overall survival rate was 60%. The 1-year overall survival rate was 100%, the 2-year survival rate was 81.8%, and the 5-year survival rate was 56.1%. The 1-year event-free survival (EFS) rate was 100%, the 2-year EFS rate was 72.7%, and the 5-year EFS rate was 49.9%. Nine patients received adjuvant radiation or chemotherapy and six patients received combined chemoradiation.Conclusions: Patients underwent orbital exenteration to treat orbital malignancies and received postoperative chemotherapy and/or radiation exhibited differences in clinical outcomes and survival rates depending on the tumor type.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Marco A. Gallón ◽  
Laura J. Echeverry ◽  
Ricardo Rojas ◽  
Margarita R. Caicedo

2021 ◽  
Vol 9 (10) ◽  
pp. e3883
Author(s):  
Mario Cherubino ◽  
Tommaso Baroni ◽  
Veronica Santoro ◽  
Leonardo Garutti ◽  
Paolo Battaglia ◽  
...  

2021 ◽  
pp. 004947552110418
Author(s):  
Pawan Agarwal ◽  
D Sharma

Orbital exenteration is a radical surgery which involves complete removal of the orbital contents along with all or parts of the eyelid. However, the eyelid complex can be totally spared in cases of necrotising disease such as mucormycosis without compromising on exposure, or fear of devascularisation of the lids. We describe a total eyelid complex preserving orbital exenteration. Preservation of the total eyelid complex has the potential to speed up the healing process and provide dynamic functional and cosmetic rehabilitation.


2021 ◽  
Vol 8 (8) ◽  
pp. 1217
Author(s):  
Neeraj Singla ◽  
Suraj Agrawal ◽  
Dimpi Bhankhur

Patients with Severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) are susceptible for developing fungal infection due to uncontrolled diabetes or immunosuppression. A 46 years male presented with diabetic ketoacidosis, respiratory failure with peri orbital blackish discoloration with SARS-Cov-2 positive report. Computed tomography (CT) chest was suggestive of perihilar ground glass opacity and multiple thick-walled cavities. Left nasal cavity scrapings revealed hyaline aseptate hyphae and growth of Rhizopus arrhizus. Patient was initially managed conservatively with liposomal amphotericin B but later underwent orbital exenteration and finally succumbed. We want to emphasize higher mortality and aggressive management of mucor mycosis when it occurs with SARS-Cov-2 as a concurrent illness.  


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