Prevention of postexenteration complications by obliteration of the orbital cavity.

OBJECTIVE: In patients for whom aggressive disease processes have necessitated the surgical removal of the orbital contents, many reconstructive options are available to address the exenteration cavity. While cavity lining, such as with a skin graft, has been commonly employed, areas of bone injury or loss may still provide a pathway for bacteria to access the cranial vault. We suggest that complete obliteration of the cavity provides a protective barrier, which minimizes this risk.
DESIGN: A retrospective review of four patients with significant intracranial infectious complications following orbital exenteration. All patients were managed at a tertiary care academic medical center.
RESULTS: Three of the four patients developed large brain abscesses, and one was symptomatic with computed tomography (CT) evidence of epidural enhancement in areas of bony dehiscence in the orbital cavity. Overall, three of the patients had free-tissue transfer to obliterate the orbit, and two of these had no further infectious problems. In one patient, the flap pulled away from the superior orbit leading to infectious complications, which were successfully managed by obliterating the remaining area of the orbit with a temporoparietal fascia flap.
CONCLUSIONS: In light of the overall prognosis of patients requiring orbital exenteration, we believe that tissue obliteration of the cavity as an initial management strategy provides advantages that outweigh the increased surgical time and loss of socket visualization.