Porcine small intestine submucosal grafts for post-tumor resection orbital reconstruction.
OBJECTIVE
Removal of the medial orbital wall for sinonasal tumor involvement is required to obtain complete oncologic resection. However, orbital fat herniation can produce significant morbidity, including enophthalmos and diplopia. The purpose of the current study was to evaluate outcomes following use of porcine small intestine submucosa (SIS) grafts for orbital reconstruction following extirpation of sinonasal malignancies.


METHODS
Case series in a tertiary hospital setting.


METHODS
Review of prospectively collected data regarding orbital reconstruction using SIS was performed. Demographics, tumor histology, size of orbital defect, adjuvant treatment, clinical status, and complications were recorded.


RESULTS
Seventeen patients (average age, 58 years; range, 27-82 years) had SIS grafting of the medial orbital wall over a 5-year period at our tertiary academic institution. The average orbital wall defect size was 4.6 cm(2) (range, 1 cm(2)-24 cm(2)). Tumor histopathology included esthesioneuroblastoma (n = 5), squamous cell carcinoma (n = 4), adenocarcinoma (n = 2), sinonasal undifferentiated carcinoma (n = 2), melanoma (n = 3), and neuroendocrine carcinoma (n = 1). Surgical goals were curative intent in all patients. Ten patients had postoperative radiation therapy, whereas five individuals had surgical extirpation following neoadjuvant chemotherapy and radiation. All patients had complete locoregional control at last clinical follow-up (average, 16 months; range, 2-54 months), although three patients developed distant metastases. The only orbital complications noted were enophthalmos (n = 1), periorbital cellulitis (n = 1), and orbital wall crusting (n = 1).


CONCLUSIONS
SIS reconstruction of orbital wall defects was effective in the current series of patients, with only one patient developing noticeable enophthalmos and a low incidence of surgical complications.


METHODS
4.
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
James
J
Phillips
Kristen O
KO
Riley
Bradford A
BA
Woodworth
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007421:Intestine, Small / Q000601:surgery / Q000637:transplantation*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D009918:Orbital Neoplasms / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D013552:Swine; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
Biodesign; Porcine small intestine submucosa; endoscopic cerebrospinal fluid leak repair; endoscopic skull base surgery; orbital reconstruction; skull base tumor