title: 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 2/3rdtemporalis 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.
authors.affiliation: a Department of Orbit and Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva Nethralaya, Beltola , Guwahati , Assam , India.
authors.forename: Kasturi
authors.initials: K
authors.lastname: Bhattacharjee
authors.affiliation: a Department of Orbit and Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva Nethralaya, Beltola , Guwahati , Assam , India.
authors.forename: Harsha
authors.initials: H
authors.lastname: Bhattacharjee
authors.affiliation: a Department of Orbit and Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva Nethralaya, Beltola , Guwahati , Assam , India.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Kuri
authors.affiliation: a Department of Orbit and Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva Nethralaya, Beltola , Guwahati , Assam , India.
authors.forename: Manpreet
authors.initials: M
authors.lastname: Singh
authors.affiliation: a Department of Orbit and Ophthalmic Plastic and Reconstructive Surgery, Sri Sankaradeva Nethralaya, Beltola , Guwahati , Assam , India.
authors.forename: Manab Jyoti
authors.initials: MJ
authors.lastname: Barman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004954:Esthetics; D005137:Eye, Artificial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D017233:Orbit Evisceration; D020273:Orbital Implants; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013703:Temporal Muscle / Q000098:blood supply / Q000601:surgery*; D013709:Tendon Transfer
keywords: Orbital reconstruction; temporalis muscle flap; total orbital exenteration; transorbitectomy approach