Exenteration
Suzanne Michalak, MD • Jason Liss, MD
DISEASE DESCRIPTION
Exenteration is an extensive procedure involving removal of the globe, eyelids, and all of the orbital soft tissues en bloc. In extreme cases, it may also include removal of adjacent bone.
MANAGEMENT OPTIONS
When orbital exenteration is indicated, few other management options remain. Depending on the extent of orbital involvement, four types of orbital exenteration can be considered — each requiring removal of increasing amounts of soft tissue and bone (Figure 36.1).
Anterior exenteration — removal of globe, posterior lamella of eyelids, and conjunctiva
Lid-sparing exenteration — removal of all orbital contents except the orbital walls and anterior lamella of the eyelids
Total exenteration — removal of orbital contents, periorbita, and eyelids
Radical exenteration — total exenteration plus removal of part of the orbital bones, paranasal sinuses, jaw, palate, and/or skull base
 FIGURE 36.1. Diagram illustrating the various types of exenteration — lid-sparing exenteration (blue), subtotal anterior exenteration (red), total exenteration (black), and radical exenteration (green). |
INDICATIONS FOR SURGERY
Exenteration is indicated primarily for life-threatening orbital malignancies or infections. These include primary orbital malignancies such as adenoid cystic carcinoma of the lacrimal gland, conjunctival and eyelid malignancies involving deep orbital tissues (such as squamous cell carcinoma, sebaceous cell carcinoma, or melanoma), intraocular malignancies with orbital invasion (eg, retinoblastoma, choroidal melanoma), nonmalignant infectious disease associated with orbital necrosis (eg, mucormycosis), and — in rare cases — benign conditions that have caused extreme orbital deformity or intractable pain.
SURGICAL DESCRIPTION
