Clin Exp Otorhinolaryngol.  2015 Mar;8(1):52-56. 10.3342/ceo.2015.8.1.52.

Reconstruction of the Orbit With a Temporalis Muscle Flap After Orbital Exenteration

• Uyar Y
• Kumral TL
• Yildirim G
• Kuzdere M
• Arbag H
• Jorayev C
• Kilic MV
• Gumrukcu S

• KMID: 1973488
• DOI: http://doi.org/10.3342/ceo.2015.8.1.52

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.

Keyword

Orbit Evisceration; Surgical Flaps; Neoplasms

MeSH Terms

Endoscopy
Female
Humans
Male
Nasal Cavity
Neoplasm Metastasis
Orbit Evisceration
Orbit*
Recurrence
Retrospective Studies
Skin
Surgical Flaps
Tissue Donors

Figure

• 

  Fig. 1 A 65-year-old man with a malignant tumor invading the orbit. (A) Preoperative photography of the exophytic malignant tumor, which invades the eye and the orbit. (B) The axial magnetic resonance imaging scans were interpreted as solid, irregular enhancement invading the eye and orbit. (C) Intraoperative operative technique of the orbital exenteration of the eye. (D) Postoperative temporalis muscle flap closure with full-thickness skin graft.

• 

  Fig. 2 The surgical technique. (A) The temporoparietal fascia is elevated with a skin flap. The zygomatic arch and lateral orbital wall of the outer surface are exposed. (B) An osteotomy is made in the zygomatic arch and the temporalis muscle flap is elevated from the junction of the perichondrium subperiosteally. (C) A tunnel is created by drilling in the lateral orbital wall, and the flap is laid down.

• 

  Fig. 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.

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