En bloc resection of lacrimal sac tumors and simultaneous orbital reconstruction: Surgical and functional outcomes

Chrisfouad Raif Alabiad, Donald Weed, Thomas J. Walker, Richard Vivero, Georges A. Hobeika, Georges F. Hatoum, Erin M. Shriver, David Tse

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Purpose: To describe a surgical technique of en bloc resection of lacrimal sac tumors by the shared expertise of 2 specialists to achieve optimal tumor margin clearance and the simultaneous reconstruction of the bony defect to preserve ocular functions and cosmesis. Methods: All patients who had resection of malignant nasolacrimal drainage system tumors using the combined technique and posttreatment protocol between 1997 and 2011 were studied in this retrospective, noncomparative, interventional case series. A combined medial maxillectomy and medial orbitotomy for en bloc resection of the lacrimal sac tumor was followed by reconstruction with a tailored contoured titanium mesh to support the globe and eyelid. Disease relapse, disease survival, ocular functions (vision loss, motility, globe dystopia, and diplopia), and cosmesis (medial canthal tendon dystopia and eyelid retraction) were documented. Results: Fourteen patients with malignant lacrimal sac tumors underwent en bloc resection. Postoperative radiation was ultimately administered to 9 patients. All patients but one were alive at last follow up. Tumor recurred locally in 2 patients with a regional recurrence in a third patient. Complications from radiation therapy included skin breakdown over the mesh (9/14 patients) with nasocutaneous fistula, medial canthal tendon dystopia (2/14 patients), and corneal perforation in a patient with recurrent disease. Despite removal of the tear drainage system, only 7 of 14 patients reported epiphora. None of the patients developed diplopia after resection and radiation therapy. Conclusions: The combined sinus-orbit approach is an effective method of managing lacrimal sac tumors to achieve optimal tumor clearance from the orbit and nasal cavity. Simultaneous reconstruction of the bony defect with a contoured titanium mesh provides a fixation anchor for the medial canthal tendon and globe support and serves as a supporting platform for the lower eyelid and cheek to minimize midface collapse. Postoperative radiation is associated with skin flap breakdown and nasocutaneous fistula formation.

Original languageEnglish (US)
Pages (from-to)459-467
Number of pages9
JournalOphthalmic Plastic and Reconstructive Surgery
Volume30
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Nasolacrimal Duct
Neoplasms
Eyelids
Tendons
Diplopia
Orbit
Titanium
Fistula
Drainage
Radiotherapy
Corneal Perforation
Radiation
Lacrimal Apparatus Diseases
Recurrence
Skin
Cheek
Nasal Cavity
Tears

ASJC Scopus subject areas

  • Ophthalmology
  • Surgery

Cite this

En bloc resection of lacrimal sac tumors and simultaneous orbital reconstruction : Surgical and functional outcomes. / Alabiad, Chrisfouad Raif; Weed, Donald; Walker, Thomas J.; Vivero, Richard; Hobeika, Georges A.; Hatoum, Georges F.; Shriver, Erin M.; Tse, David.

In: Ophthalmic Plastic and Reconstructive Surgery, Vol. 30, No. 6, 2014, p. 459-467.

Research output: Contribution to journalArticle

Alabiad, Chrisfouad Raif ; Weed, Donald ; Walker, Thomas J. ; Vivero, Richard ; Hobeika, Georges A. ; Hatoum, Georges F. ; Shriver, Erin M. ; Tse, David. / En bloc resection of lacrimal sac tumors and simultaneous orbital reconstruction : Surgical and functional outcomes. In: Ophthalmic Plastic and Reconstructive Surgery. 2014 ; Vol. 30, No. 6. pp. 459-467.
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N2 - Purpose: To describe a surgical technique of en bloc resection of lacrimal sac tumors by the shared expertise of 2 specialists to achieve optimal tumor margin clearance and the simultaneous reconstruction of the bony defect to preserve ocular functions and cosmesis. Methods: All patients who had resection of malignant nasolacrimal drainage system tumors using the combined technique and posttreatment protocol between 1997 and 2011 were studied in this retrospective, noncomparative, interventional case series. A combined medial maxillectomy and medial orbitotomy for en bloc resection of the lacrimal sac tumor was followed by reconstruction with a tailored contoured titanium mesh to support the globe and eyelid. Disease relapse, disease survival, ocular functions (vision loss, motility, globe dystopia, and diplopia), and cosmesis (medial canthal tendon dystopia and eyelid retraction) were documented. Results: Fourteen patients with malignant lacrimal sac tumors underwent en bloc resection. Postoperative radiation was ultimately administered to 9 patients. All patients but one were alive at last follow up. Tumor recurred locally in 2 patients with a regional recurrence in a third patient. Complications from radiation therapy included skin breakdown over the mesh (9/14 patients) with nasocutaneous fistula, medial canthal tendon dystopia (2/14 patients), and corneal perforation in a patient with recurrent disease. Despite removal of the tear drainage system, only 7 of 14 patients reported epiphora. None of the patients developed diplopia after resection and radiation therapy. Conclusions: The combined sinus-orbit approach is an effective method of managing lacrimal sac tumors to achieve optimal tumor clearance from the orbit and nasal cavity. Simultaneous reconstruction of the bony defect with a contoured titanium mesh provides a fixation anchor for the medial canthal tendon and globe support and serves as a supporting platform for the lower eyelid and cheek to minimize midface collapse. Postoperative radiation is associated with skin flap breakdown and nasocutaneous fistula formation.

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