Single-stage socket reconstruction with vascularised temporalis muscle flap following total orbital exenteration: Description of 3 surgical approaches

ABSTRACT

We describe the techniques and outcome of three different approaches to transfer the posterior 2/3^rd temporalis muscle pedicle flap for orbital socket reconstruction following total orbital exenteration. A retrospective interventional series of 9 patients operated between February of 2000 and 2006. We describe three different techniques, namely supraorbital, transorbital and transorbitectomy approach. All patients were followed for minimum of 3 years and muscle trophism with periorbital contour was clinically studied for outcome. There were 6 males and 3 females with a mean age of 42 years. Three patients each underwent the three mentioned approaches of socket reconstruction following total orbital exenteration performed mainly for oculo-adenexal malignancies with orbital extension (77.78%). Intraoperative, tumor-free histopathological margins were ensured. Postoperatively, bulky lateral orbital rim was noticed in all 3 patients of supraorbital approach, while progressive temporalis flap atrophy was noticed in all with transorbital approach over a period of 6 months. No such complications were observed in transorbitectomy approach and reasonably good periorbital cosmetic appearance with optimum preservation of muscle trophism was obtained. The mean follow-up period was 7 years. Temporalis muscle flap provides adequate orbital volume restoration in an exenterated socket. It also helps in better skin graft uptake, socket health and appearance. The transorbitectomy approach appeared as a reliable one stage surgical technique with reasonably acceptable anatomical and cosmetic outcome over a long-term follow-up. The choice of posterior portion of temporalis muscle as a flap offers satisfactory temporal fossa appearance.

KEYWORDS:

• Orbital reconstruction
• temporalis muscle flap
• total orbital exenteration
• transorbitectomy approach

Acknowledgments

The authors would like to thank Dr. Bhaskar Borkotoky, Consultant, Department of Plastic Surgery, Downtown Hospital, Guwahati, Assam, India for his assistance.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

The authors appreciate the funding from the Sri Kanchi Sankara Health & Educational Foundation, Beltola, Guwahati, Assam, India.

Additional information

Funding

The authors appreciate the funding from the Sri Kanchi Sankara Health & Educational Foundation, Beltola, Guwahati, Assam, India.