2020–2021 BCSC Basic and Clinical Science Course™
7 Oculofacial Plastic and Orbital Surgery
Part I: Orbit
Chapter 8: The Anophthalmic Socket
Types of Exenteration
Exenterations can be categorized according to the amount of tissue that is removed. Following are the types of exenteration:
Subtotal. The eye and adjacent intraorbital tissues are removed so that the lesion is locally excised (leaving part of the periorbita and eyelids). This technique is used for some locally invasive tumors, for debulking of disseminated tumors, or for partial treatment in selected patients.
Total. All intraorbital soft tissues, including periorbita, are removed, with or without the skin of the eyelids (Fig 8-14A).
Extended. All intraorbital soft tissues are removed, together with adjacent structures (usually bony walls and sinuses).
The technique selected depends on the pathologic process. The goal is to remove all lesions along with appropriate margins of adjacent tissue while retaining as much healthy tissue as possible. Following removal of the orbital contents, the bony socket may be allowed to spontaneously granulate and epithelialize, or it may be covered by a split-thickness skin graft (Fig 8-14B) or collagen skin replacement. The graft or skin replacement may be placed onto bare bone or over a temporalis muscle or temporoparietal fascial flap. Rehabilitation after exenteration may include a prosthesis attached to an eyeglasses frame, to the periorbital area (with adhesive), or to an osseointegrated implant, which may be facilitated with magnetic posts (Fig 8-15). The exenteration prosthesis restores the tissues that have been removed, including eyelids and an eye, but it does not blink or move.
Wei LA, Brown JJ, Hosek DK, Burkat CN. Osseointegrated implants for orbito-facial prostheses: preoperative planning tips and intraoperative pearls. Orbit. 2016;35(2):55–61.
Figure 8-14 Total exenteration and reconstruction. A, Total exenteration of the left orbit for invasive squamous cell carcinoma. B, Socket reconstruction using a split-thickness skin graft.
(Courtesy of Bobby S. Korn, MD, PhD.)
Figure 8-15 Osseointegrated prosthesis placement after exenteration. A, Osseointegrated magnetic coupling implants in the right orbit after exenteration. B, Front view of orbitofacial prosthetic. C, Back view of orbitofacial prosthetic with ferromagnetic posts. D, Orbitofacial prosthetic in place using magnetic fixation showing excellent contour to the skin.
(Parts A, B, D courtesy of Keith D. Carter, MD; part C courtesy of Cat N. Burkat, MD.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.