Orbital Exenteration for Skin Malignancies: A Single-Center Experience

Background and Aim: Orbital exenteration is a rare, mutilating procedure reserved for treatment of locally invasive malignancy or potentially life-threatening orbital neoplasms, and used only when less destructive techniques are inadequate. The aim of this study is to report our experience and analyze data of patients who were subject to orbital exenteration, and to identify key factors affecting mortality associated with the surgical procedure.

Material and Methods: Fourteen cases of orbital exenteration were performed over a 10-year period. Records were reviewed retrospectively of all patients who had undergone exenteration of the orbit from 1997 to 2007 at the Oral Maxillofacial Surgery Department of Theagenio Cancer Hospital. Kaplan-Meier analysis was used to estimate survival following exenteration.

Results: There were 12 male and 2 female patients. Mean age was 65 years (range, 50–80 years). In nine patients, the left eye was infiltrated. Overall, 5-year survival after exenteration was high at 93%(1 death). Histological types were: SCC, five patients; BCC, four patients; basosquamous, five patients. Restoration was with local, regional flaps and free half-thickness skin tissue transfer grafts. Adjuvant radiotherapy was administered to five patients, and four patients required a second operation. Prosthetic restoration was only placed in one patient, without success. There were two recurrences (SCC) and three paranasal sinus shunts.

Conclusions: Patients in need of orbital exenteration are usually neglected persons, without a supportive family environment. In this context, aesthetic restoration and emotional well-being can be difficult to achieve.