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Reconstruction of the orbit with a temporalis muscle flap after orbital exenteration.

Uyar Y, Kumral TL, Yıldırım G, Kuzdere M, Arbağ H, Jorayev C, Kılıç MV, Gümrükçü SS - Clin Exp Otorhinolaryngol (2015)

Bottom Line: No visible defects in the muscle flap donor site were present.Local recurrences were readily followed up with nasal endoscopy, whereas radiology helped to diagnose intracranial involvement in three patients.Two patients died of systemic metastases and five died for other reasons.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Okmeydanı Training and Reseach Hospital, Istanbul, Turkey.

ABSTRACT

Objectives: This study presents the role of the temporalis muscle flap in primary reconstruction after orbital exenteration.

Methods: A retrospective nonrandomized study of orbital exenterations performed between 1990 and 2010 for malignant tumors of the skin, paranasal sinus, and nasal cavity is presented.

Results: The study included 13 patients (nine men, four women; age range, 30-82 years) with paranasal sinus, nasal cavity, or skin carcinomas. Primary reconstruction of the cavity was performed in all patients after orbital exenteration. No visible defects in the muscle flap donor site were present. Local recurrences were readily followed up with nasal endoscopy, whereas radiology helped to diagnose intracranial involvement in three patients. Two patients died of systemic metastases and five died for other reasons.

Conclusion: The temporalis muscle flap is readily used to close the defect after orbital exenteration, and does not prevent the detection of recurrence.

No MeSH data available.


Related in: MedlinePlus

A 54-year-old woman with squamous cell carcinoma in the ethmoid sinus invading the left orbit. (A) Preoperative photography of the patient with proptosis in the left eye. (B) The axial computed tomography scans were interpreted as a solid mass in the etmoid air cells invading the nasal septum, left lamina papyracea and left optic nerve. (C) Intraoperative operative technique of the tunnel created to ensure the passage of the temporalis muscle flap to the orbit. (D) Postoperative temporalis muscle flap closure with the eyelid skin.
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Figure 3: A 54-year-old woman with squamous cell carcinoma in the ethmoid sinus invading the left orbit. (A) Preoperative photography of the patient with proptosis in the left eye. (B) The axial computed tomography scans were interpreted as a solid mass in the etmoid air cells invading the nasal septum, left lamina papyracea and left optic nerve. (C) Intraoperative operative technique of the tunnel created to ensure the passage of the temporalis muscle flap to the orbit. (D) Postoperative temporalis muscle flap closure with the eyelid skin.

Mentions: The main concerns stemming from in this procedure are the creation of adequate tumor-free margins and the preservation of as much normal periocular soft tissue as possible for reconstruction. The orbital cavity was repaired with a temporalis muscle flap in all cases. An incision is made from the anterior edge of the tragus to the superior edge of the orbit (Fig. 1C). While avoiding the frontal nerve, the temporoparietal fascia is elevated from the surface of the inner layer with fatty tissue (Fig. 2A). In this manner, the zygomatic arch and lateral orbital wall of the outer surface are exposed. An osteotomy is made in the zygomatic arch. The muscle flap is elevated from the junction of the perichondrium subperiosteally (Fig. 2B). A tunnel is created by drilling in the lateral orbital wall (frontozygomatic rim) (Figs. 2C, 3C). If the eyelid is not included in the specimen, it is sutured to the muscle prepared as the flap (Fig. 3D). If it is resected, a full-thickness skin graft taken from the inguinal area is sutured over the muscle without tension (Fig. 1D). The temporalis muscle is covered by passing it through the tunnel. The edges of the muscle wall are attached to the orbit and the nasal bones (Figs. 1, 3).


Reconstruction of the orbit with a temporalis muscle flap after orbital exenteration.

Uyar Y, Kumral TL, Yıldırım G, Kuzdere M, Arbağ H, Jorayev C, Kılıç MV, Gümrükçü SS - Clin Exp Otorhinolaryngol (2015)

A 54-year-old woman with squamous cell carcinoma in the ethmoid sinus invading the left orbit. (A) Preoperative photography of the patient with proptosis in the left eye. (B) The axial computed tomography scans were interpreted as a solid mass in the etmoid air cells invading the nasal septum, left lamina papyracea and left optic nerve. (C) Intraoperative operative technique of the tunnel created to ensure the passage of the temporalis muscle flap to the orbit. (D) Postoperative temporalis muscle flap closure with the eyelid skin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4338092&req=5

Figure 3: A 54-year-old woman with squamous cell carcinoma in the ethmoid sinus invading the left orbit. (A) Preoperative photography of the patient with proptosis in the left eye. (B) The axial computed tomography scans were interpreted as a solid mass in the etmoid air cells invading the nasal septum, left lamina papyracea and left optic nerve. (C) Intraoperative operative technique of the tunnel created to ensure the passage of the temporalis muscle flap to the orbit. (D) Postoperative temporalis muscle flap closure with the eyelid skin.
Mentions: The main concerns stemming from in this procedure are the creation of adequate tumor-free margins and the preservation of as much normal periocular soft tissue as possible for reconstruction. The orbital cavity was repaired with a temporalis muscle flap in all cases. An incision is made from the anterior edge of the tragus to the superior edge of the orbit (Fig. 1C). While avoiding the frontal nerve, the temporoparietal fascia is elevated from the surface of the inner layer with fatty tissue (Fig. 2A). In this manner, the zygomatic arch and lateral orbital wall of the outer surface are exposed. An osteotomy is made in the zygomatic arch. The muscle flap is elevated from the junction of the perichondrium subperiosteally (Fig. 2B). A tunnel is created by drilling in the lateral orbital wall (frontozygomatic rim) (Figs. 2C, 3C). If the eyelid is not included in the specimen, it is sutured to the muscle prepared as the flap (Fig. 3D). If it is resected, a full-thickness skin graft taken from the inguinal area is sutured over the muscle without tension (Fig. 1D). The temporalis muscle is covered by passing it through the tunnel. The edges of the muscle wall are attached to the orbit and the nasal bones (Figs. 1, 3).

Bottom Line: No visible defects in the muscle flap donor site were present.Local recurrences were readily followed up with nasal endoscopy, whereas radiology helped to diagnose intracranial involvement in three patients.Two patients died of systemic metastases and five died for other reasons.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Okmeydanı Training and Reseach Hospital, Istanbul, Turkey.

ABSTRACT

Objectives: This study presents the role of the temporalis muscle flap in primary reconstruction after orbital exenteration.

Methods: A retrospective nonrandomized study of orbital exenterations performed between 1990 and 2010 for malignant tumors of the skin, paranasal sinus, and nasal cavity is presented.

Results: The study included 13 patients (nine men, four women; age range, 30-82 years) with paranasal sinus, nasal cavity, or skin carcinomas. Primary reconstruction of the cavity was performed in all patients after orbital exenteration. No visible defects in the muscle flap donor site were present. Local recurrences were readily followed up with nasal endoscopy, whereas radiology helped to diagnose intracranial involvement in three patients. Two patients died of systemic metastases and five died for other reasons.

Conclusion: The temporalis muscle flap is readily used to close the defect after orbital exenteration, and does not prevent the detection of recurrence.

No MeSH data available.


Related in: MedlinePlus