BACKGROUND:
Since the ocular adnexa contains almost every tissue type, any malignancy may occur in this area, however, the majority are carcinomas, from which basal cell carcinomas (BCC) are the most frequent, followed by; squamous cell carcinoma (SCC), sebaceous gland carcinoma, malignant melanoma. Reconstructing periorbital defects should aim at restoring functional as well as aesthetic improvement (1). Planning of the surgical reconstruction is tempered by several factors including; nature of the defect, integrity of the surrounding tissues, in some cases multiple choices of repair available making planning more complex, as in the medial canthal area (2).
OBJECIVE:
Analyze the most suitable methods of reconstruction of different periorbital defects of different sizes and in different sites.
Analyzing the incidence of recurrence and complications of tumors after surgical excision.
METHODS:
Thirty patients presented with 34 malignant lesion in the periorbital area. The lesions were excised surgically, and the post-excisional defects were classified into five zones in the periorbital area, and were reconstructed using different modalities of reconstruction.
RESULTS:
Out of the 34 lesions, basal-cell carcinoma formed the majority (52.9%), mainly nodular type. Squamous-cell lesions come next in frequency forming (23.5%). Baso-squamous (15%), other tumors (9%). The most presenting symptoms were: ulceration with or without infection (38.2%). Primary closure was done for (26.4%) of cases, same number was reconstructed by STSG. FTSGs formed (17.6%). Local flap used in (23.5%).
CONCLUSION:
In reconstructing periorbital defects; size of the defect, site and state of the surrounding tissues determine the mode of reconstruction. Flaps are superior to grafts in term of lower incidence of complications and aesthetic outcome, whereas grafts remain better to detect early recurrence.
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- Akira Saito, Noriko Saito, Hirishi Furukawa. Reconstruction of periorbital defects following malignant tumor excision: A report of 50 cases: Journal of plastic, reconstructive and aesthetic surgery. 2012; 65: 665-70.
- Craig N. Cziz, Kenneth V. Cahill, Jill A. Foster. Reconstructive options for medial canthus and eyelids following tumor excision: Saudi Journal of Ophthalmology. 2011; 25, 67-74.
- Serdar Yuce, Zuhtu Demir, Caferi Tayyar Selcuk, Selim Celebioglu. Reconstruction of periorbital region defects: A retrospective study. Annuals of maxillofacial surgery. 2014; 4:45-50.
- Kumar U., Jain P. Reconstruction of the eyelid and periocular region ; our experience. JMSoc 2018; 32: 135-39.
- Scott M. Hayano, Katherine M. Whipple, Bobby S. Korn, and Don O. Kikkawa. Principles of periocular reconstruction following excision of cutaneous malignancy. Journal of skin cancer. 2012:DOI: 10.1155/2012/438502
- Cook BE Jr., Bartley GB. Treatment options and future prospects for the management of eyelid malingnancies; an entence-based update. Ophthalmology 2001; 108: 2088-98.
- Donaldson MJ, Sullivan TJ, Whitehead KJ, Williamson RM. Squamous cell carcinoma of the eyelids. Br. J. Ophthalmol 2002;86:1161-65.
- F Irvine, A. A. McNab. A technique for reconstruction of upper lid marginal defect. Br J Ophthalmol 2003;87:279-81.
- Wong VA, Marshall JA, Whitehead KJ, Williamson KM, Sullivan TJ. Management of periocular basal-cell carcinoma with modified enface frozen section controlled excision. Opthalmic plast reconstr surg. 2002; 18: 430-35.
- Suzanne K. Freitag, N. Grace Lee, Daniel K. LeFebvre, Micheal K. Yoon. Eyelid reconstruction, 1st. ed., Thieme, 2020:32.
- Guilherme Castela. Mannual of ophthalmic plastic and reconstructive surgery, 1st ed., societate portuguesa de oftalmologia, 2016: 141.
- R. F. Guthoff, J. A. Katowitz. Oculoplastics and orbit, 1st ed., springer,2007:14.
- Subramanian N. Reconstruction of eyelid defect. Indian J plast surg. 2011; 44:5-13.
- Henry M. Spinelli, Glenn W. Jelks. Periocular reconstruction ; A systematic approach, plastic and reconstructive surgery, 1993; 91:1017-24.
- Somen Misra, Kunal Patill, Neeta Misra, Aayush Tandon. Epidemiological study and treatment outcome of primary ocular and adnexal malignancies in a rural Indian tertiary eye care center. Nigerian Journal of Ophthalmology. 2016;24: 67-70.
- Mark A. Codner, Clinton D. McCord, Juan Diego Mejia, Don laloute. Upper and lower eyelid reconstruction, plastic and reconstructive surgery, 2010;l 126: 231e-240e.
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