Total orbital exenteration - Experience from a tertiary cancer care center in Northern India

Introduction: Orbital exenteration (OE) is a defacing procedure reserved for advanced head and neck malignancies involving the orbit. Even though it is cosmetically unappealing and associated with complete loss of vision in one eye, the procedure has low surgical morbidity and recurrence rates and should be considered in appropriate patients after adequate patient counseling. Due to relative rarity of the procedure, there is a paucity of literature, particularly in India. Aim: To analyze the role and indications of OE, operative details, morbidity, and postoperative complications in patients who had undergone total OE in a tertiary care cancer hospital. Materials and Methods: We retrospectively reviewed 5-year (2011–2016) data of those who had OE from our computerized database. The retrieved data were analyzed for demographic profile, operative details, morbidity, and survival rates. Results: Out of 20 patients analyzed, 13 were male and 7 were female. Majority of the patients have secondary eyeball extension (15/20). Most frequent indication for exenteration was tumor of eyelid origin. Reconstruction after surgery was done by temporalis flap (n = 10), anterolateral thigh-free flap (n = 6), and split skin graft (n = 4). None of the patients had any intraoperative complications. One patient developed flap necrosis and managed by flap revision. One patient had wound dehiscence and managed conservatively. At a mean follow-up of 20 ± 9.6 months, two patients had recurrence of primary disease. Mortality occurred in two patients; 1 case for disease related and another one for other medical condition. Conclusion: The OE has still a role and is indicated for a variety of conditions. The surgical procedure remains safe, and major morbidity is dictated by the type of reconstruction. Although skin graft is the simplest reconstructive option, many a times, myocutaneous/free flap is required in advanced cases.