Ueda Misato, Shinomiya Hirotaka, Nibu Ken-Ichi, Kimura Hidehito, Nomura Tadashi
Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN.
Department of Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, JPN.
Cureus. 2024 Sep 13;16(9):e69310. doi: 10.7759/cureus.69310. eCollection 2024 Sep.
In cases of lacrimal gland carcinoma requiring surgical excision of the orbital contents, skull base, and surrounding bones, definitive blockage of the cranial cavity and reconstruction of the anterior skull base with irradiation-acceptable tissue (for possible subsequent radiotherapy) is necessary. However, considerations for quality of life, including cosmetic aspects, such as artificial eye placement and contour morphology, make reconstruction challenging. In three cases of advanced lacrimal gland carcinoma, we performed a reconstruction surgery following an en bloc resection of the orbital contents and lateral orbital bones. A rectus abdominis flap was used, considering both function and morphology. This flap, characterized by reliable anatomical structure and good blood flow, adequately filled the three-dimensional dead space. In our case, the flap fully survived, and no complications such as cerebrospinal fluid leakage or meningitis were observed. Six months after surgery, the flap volume was 31.7-73.3% of its initial size. Considering potential flap shrinkage in the future, it was deemed beneficial to use a slightly excessive volume.
对于需要手术切除眼眶内容物、颅底及周围骨骼的泪腺癌病例，必须对颅腔进行确定性封闭，并用可接受放疗的组织重建前颅底（以便后续可能进行的放疗）。然而，考虑到生活质量，包括美容方面，如义眼植入和轮廓形态，重建具有挑战性。在三例晚期泪腺癌病例中，我们在整块切除眼眶内容物和眶外侧骨后进行了重建手术。考虑到功能和形态，使用了腹直肌皮瓣。该皮瓣具有可靠的解剖结构和良好的血流，充分填充了三维死腔。在我们的病例中，皮瓣完全存活，未观察到脑脊液漏或脑膜炎等并发症。术后六个月，皮瓣体积为初始大小的31.7 - 73.3%。考虑到皮瓣未来可能会收缩，使用略大的体积被认为是有益的。
