What is exenteration?
Exenteration or orbital exenteration refers to the removal of the entirety of orbital contents which may include the periorbital structures and the eyelids. Exenteration surgery is usually carried out in the case of extensive orbital disease or malignancy. In case it is possible, the eyelid skin and orbicularis muscle are retained to aid post-operative healing. It is a highly specialized facial operation and is performed by a specialist known as an oculoplastic surgeon.
When is exenteration surgery necessary?
Exenteration surgery is only carried out in the case of extensive orbital disease or malignancy which is progressing at a rapid rate and is potentially life threning. 40-50% of the exenterations performed by oculoplastic surgeons result from tumors origination in the eyelid or the periocular skin. Of these, basal cell carcinoma makes up almost 90% and squamous cell and sebaceous gland carcinoma account for 4-6% each. Exenteration surgery can control the further spread of the malignancy and prevent metastasis.
How is exenteration carried out?
The oculoplastic procedure involving exenteration is carried out under general anesthesia, preferably with endotracheal intubation. Injection of adrenaline into the tissues prior to operation may be carried out to reduce bleeding and aid hemostasis. A firm incision is made down to the bone along the orbital rim. The bleeding tissue is secured with artery forceps and subsequently ligated or diathermied. Next, the periosteum is incised along the orbital rim. Orbital apex tissues are then divided using curved scissors or a scalpel blade. This results in profuse bleeding which is staunched by applying pressure or heat. Once the surgery is complete, the orbit may be packed immediately and a skin graft can be performed once the wound is healed. In case the hemostasis immediately after surgery is very good, a skin graft can be placed immediately.
Post-operative care for the surgical wound involves systemic antibiotics and painkillers for a few days. Orbital packing is removed after 10 days. In some cases, a secondary skin graft may be necessary and can be carried out once the wound has healed.
What are the risks associated with orbital exenteration?
The following risks are associated with orbital exenteration:
- Development of an orbital cyst in rare cases
- Long-term throbbing orbital pain
- Earaches and other ear problems
- Recurrence of malignancy
Exenteration surgery is an extensive oculoplastic procedure and must be carried out only after extensive pre-operative diagnostic procedures and examination. A specialist oculoplastic surgeon and ocular oncology specialist must be consulted for thorough evaluation of the cancer, the extent of the malignancy and its potential for further spread. Exenteration is a complex procedure with considerable consequences on the patient, physically as well as psychologically. The patient must be well apprised with the surgical procedure, any post-operative precautions as well as risks associated with the surgery.
Exenteration surgery is a significant surgical procedure and must only be carried out by an experienced and licensed oculoplastic surgeon to avoid any post-operative complications.
Dr. Debraj Shome is a highly experienced expert in oculoplastic surgery and has several accolades to his name. He is a consultant at Apollo Hospitals and Saifee Hospitals in Bombay, and has gained immense expertise in the field of oculoplastic surgery.