Tiwari R, van der Wal J, van der Waal I, Snow G
Department of Otolaryngology, Head & Neck Surgery, University Hospital VU, Amsterdam, The Netherlands.
Head Neck. 1998 May;20(3):193-6. doi: 10.1002/(sici)1097-0347(199805)20:3<193::aid-hed2>3.0.co;2-w.
The periorbita has been traditionally regarded as the decisive layer whose involvement in carcinoma of maxillary sinus indicates orbital exenteration. Anatomic texts depict that the orbital fat rests on the periorbita. Our experience at surgical dissections has been different.
Twenty-five patients underwent total maxillectomy for advanced (T3-T4) carcinoma of the maxillary sinus with postoperative radiotherapy during a 15-year period between 1981 and 1995. In 11 patients, despite radiologic evidence of orbital invasion, and in 5 patients with infiltration of the periorbita, the eye could be preserved without evidence of recurrence. In 6 patients who in addition underwent orbital exenteration, histopathologic evidence of tumor invasion of the orbit was present in only one surgical specimen.
Clinicoanatomic studies have clearly shown the presence of a thin, distinct fascial layer which surrounds the periocular fat and separates it from the periorbita. Neither clinical examination nor imaging could predict orbital invasion with absolute accuracy. Histopathologic examination of the surgical specimens shows that tumor infiltration of the eye is rare.
Periocular fat is surrounded by a thin fascial layer and is not in direct contact with the periorbita. Intraoperative decision making with respect to preservation of the eye is sometimes essential.
眶周组织传统上被视为上颌窦癌累及的决定性层次，其受累提示需行眶内容摘除术。解剖学文献描述眶脂肪位于眶周组织之上。然而，我们的手术解剖经验却有所不同。
在1981年至1995年的15年间，25例晚期（T3 - T4）上颌窦癌患者接受了全上颌骨切除术并术后放疗。11例患者尽管有影像学证据显示眼眶受侵，5例患者眶周组织有浸润，但仍成功保留了眼球且无复发迹象。另外6例行眶内容摘除术的患者中，仅1例手术标本有肿瘤侵犯眼眶的组织病理学证据。
临床解剖学研究清楚地表明，存在一层薄而清晰的筋膜层，它围绕着眶周脂肪并将其与眶周组织分隔开。临床检查和影像学检查均无法绝对准确地预测眼眶受侵情况。手术标本的组织病理学检查显示，肿瘤侵犯眼球的情况很少见。
眶周脂肪被一层薄筋膜层所包围，并不直接与眶周组织接触。术中关于保留眼球的决策有时至关重要。
