• Oculoplastics/Orbit

    Review of: Total orbital exenteration with temporalis muscle transfer and secondary healing

    Lemaître S, Green F, Dendale R, et al. Canadian Journal of Ophthalmology, February 2022

    To expedite postsurgical healing, surgeons at a single center in France created a technique for single-stage repair following total orbital exenteration.

    Study design

    This retrospective study looked at 29 patients who underwent total orbital exenteration for orbital malignancy between 2009 and 2016. Eighteen of the 29 patients had a diagnosis of conjunctival melanoma. Following exenteration, reconstruction was performed via an ipsilateral temporalis flap passed through an ostomy in the lateral orbital wall; the skin was then allowed to heal by secondary intent.

    Outcomes

    Total orbital exenteration led to complete tumor excision in 25 patients. Complete epithelialization was achieved within an average of 7.9 weeks. The rate of postoperative complications was similar to those seen with other surgical exenteration reconstruction methods. 

    Limitations

    This is a retrospective study with short follow-up times. Information from longer postoperative courses would substantiate the findings. In addition, sino-orbital fistulas frequently occur with these types of reconstructions.

    Clinical significance

    This is a new surgical approach to exenteration reconstruction that might be very useful for patients hoping to have a more expedited cosmetic outcome. Patients can have single-stage repair with a potential for a shorter healing process, with complete epithelialization occurring within 1–2 months. This method also allows for placement of an osseous integrated prosthesis. The addition of a synthetic skin layer over the temporalis could be considered in the future.