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Skull Base 2007; 17(3): 197-203
DOI: 10.1055/s-2007-977468
ORIGINAL ARTICLE

Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Prevention of Postexenteration Complications by Obliteration of the Orbital Cavity

Jeffrey H. Spiegel1 , Mark A. Varvares2
  • 1Department of Otolaryngology-Head and Neck, Boston University School of Medicine, Boston, Massachusetts
  • 2Department of Otolaryngology-Head and Neck Surgery, St. Louis University, St. Louis, Missouri
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Publication History

Publication Date:
11 May 2007 (online)

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Commentary “Prevention of Postexenteration Complications by Obliteration of the Orbital Cavity”Skull Base 2007; 17(03): 202-203
DOI: 10.1055/s-2007-977469

ABSTRACT

Objective: In patients for whom aggressive disease processes have necessitated the surgical removal of the orbital contents, many reconstructive options are available to address the exenteration cavity. While cavity lining, such as with a skin graft, has been commonly employed, areas of bone injury or loss may still provide a pathway for bacteria to access the cranial vault. We suggest that complete obliteration of the cavity provides a protective barrier, which minimizes this risk. Design: A retrospective review of four patients with significant intracranial infectious complications following orbital exenteration. All patients were managed at a tertiary care academic medical center. Results: Three of the four patients developed large brain abscesses, and one was symptomatic with computed tomography (CT) evidence of epidural enhancement in areas of bony dehiscence in the orbital cavity. Overall, three of the patients had free-tissue transfer to obliterate the orbit, and two of these had no further infectious problems. In one patient, the flap pulled away from the superior orbit leading to infectious complications, which were successfully managed by obliterating the remaining area of the orbit with a temporoparietal fascia flap. Conclusions: In light of the overall prognosis of patients requiring orbital exenteration, we believe that tissue obliteration of the cavity as an initial management strategy provides advantages that outweigh the increased surgical time and loss of socket visualization.

KEYWORDS

Orbit exenteration - brain abscess - reconstruction

REFERENCES

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Mark A VarvaresM.D. 

Department of Otolaryngology-Head and Neck Surgery, St. Louis University

3635 Vista at Grand Blvd., St. Louis, MO 63110

Email: Varvares@slu.edu

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