Cinar Can, Arslan Hakan, Bingol Ugur Anil, Aydin Yagmur, Cetinkale Oguz
*Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Yeditepe University †Department of Plastic and Reconstructive Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Atasehir, Turkey.
J Craniofac Surg. 2017 Oct;28(7):1687-1693. doi: 10.1097/SCS.0000000000003746.
The unique anatomy of the orbita and the different behavior of each malignant tumor cause us to perform the various types of orbital exenteration that yields to varying defect each of which has own specific demands in terms of the reconstruction. Current classification of orbital exenteration defects seems not to be adequate to provide detailed description. This study reviews 50 exenteration defects to offer a more effective anatomical classification system.
Over a 15 years period, 50 orbital exenteration defects in 47 patients were reconstructed. Defects were categorized according to the resected orbital wall, dura, and ethmoid resection. If the maxillectomy was performed, A or B was added to define the type of maxillectomy as partial (intact palate) or total maxillectomy, respectively. According to these criteria, 4 types of defect patterns were determined including Type 0 (n = 5) with intact orbital wall, Type I (n = 9) with sino-orbital fistula, Type II (n = 4) with crania-orbital fistula with intact dura, Type III (n = 6) with crania-orbital fistula associated with dura defect, and Type IV (n = 8) with cranio-nasal-orbital fistula. There were 12 partial (A) and 6 total maxillectomy (B) defects along with the orbital exenteration.
There was no major complication except one. The minor wound-healing problems occurred in 7 patients. Nine patients (19%) used prosthesis. Twenty-two (46.8%) patients chose a patch to cover the area. The remaining 16 patients were not able to use any type of prosthesis because of the reconstruction methods.
The authors believe that the authors' anatomical classification system provides more precise description of the defect which eventually enhances the success rate of both reconstruction and resection.
眼眶独特的解剖结构以及每种恶性肿瘤的不同特性，促使我们开展各种类型的眼眶内容剜除术，而这会导致不同的缺损情况，每种缺损在重建方面都有其特定要求。目前眼眶内容剜除术缺损的分类似乎不足以提供详细描述。本研究回顾了50例眼眶内容剜除术缺损情况，以提供一种更有效的解剖学分类系统。
在15年期间，对47例患者的50例眼眶内容剜除术缺损进行了重建。根据切除的眶壁、硬脑膜和筛窦切除情况对缺损进行分类。如果进行了上颌骨切除术，则分别添加A或B来定义上颌骨切除术的类型为部分（腭部完整）或全上颌骨切除术。根据这些标准，确定了4种缺损模式，包括眶壁完整的0型（n = 5）、伴有鼻窦-眼眶瘘的I型（n = 9）、硬脑膜完整的颅-眼眶瘘的II型（n = 4）、伴有硬脑膜缺损的颅-眼眶瘘的III型（n = 6）以及颅-鼻-眼眶瘘的IV型（n = 8）。眼眶内容剜除术同时伴有12例部分（A）和6例全上颌骨切除术（B）缺损。
除1例患者外，无其他严重并发症。7例患者出现轻微伤口愈合问题。9例患者（19%）使用了假体。22例（46.8%）患者选择用贴片覆盖该区域。其余16例患者由于重建方法无法使用任何类型的假体。
作者认为作者的解剖学分类系统能更精确地描述缺损情况，最终提高重建和切除的成功率。
