Clinical Study Of Orbital Tumors Treated With Different Orbital Surgical Procedures

ObjectiveAnatomical structure of orbit is complex, and the tumor disease occurs in orbit for various. Currently in operation in treatment of tumor of the orbit mainly due to tumor location, nature, size, different ways, surgery is also different. Commonly used surgical approaches have anterior orbitotomy, lateral orbitotomy, medial orbitotomy, combined lateral and medial orbitotomy, transfrontal orbitotomy and exenteration of the orbit, etc. Operation fine orbit, especially in deep tumor, easy orbital infringing optic never, operation difficulty big, complication also more, one of the most serious complications is losing of vision. In recent years, with the development of the imaging and the improvement of surgical skills, orbit surgical methods and the indications also changed. This paper retrospectively analyze1011cases (1007patients) of different orbital tumors with different orbital surgical procedures, and analyze the ways, surgical approaches, effects and complications of orbitotomy.MethodsDifferent orbitotomy for1011cases (1007patients) of the10leading orbital tumors were performed in our department from1998to2013, which were confirmed by pathology. There were cavernous hemangioma (264), vascular leiomyoma (147), pleomorphic adenoma of the lacrimal gland (102), schwannoma (101), inflammatory pseudotumor (95,92patients), epidermoid and dermoid cyst (88), lymphoma (72,71patients), meningioma (52), adenoid cystic carcinoma (48), varix (42). Different orbital surgical procedures of choice in different tumor location, nature were analyed. Contrast of anterior orbitotomy and lateral orbitotomy in tumor resection, postoperative complications and recurrence.Results1. Surgical approach:There were752cases (748patients) of anterior orbitotomy,255cases of lateral orbitotomy,2cases of medial orbitotomy,18cases of combined lateral and medial orbitotomy, and14cases of exenteration of the orbit. Anterior orbitotomy include supraorbital eyebrow incision (285cases), inferior conjunctival fornix approach (280cases), superomedial conjunctival fornix approach (147cases), superolateral conjunctival approach (25cases), upper eyelid incision (6cases) and subciliary approach (9cases).2. All of the tumors were removed completely except82cases were partial removed. This study compared the residual tumor rate of anterior orbitotomy and lateral orbitotomy, and no statistical significance was found (P>0.05).3. The early postoperative complications (1weeks):Visual acuity of237cases decreased, including17cases of accidental vision loss. Some extent ptosis occurred in218cases, including96cases of levator muscle myodynamia loss. Extraocular muscle impairment was found in274cases, and deformed pupil in10cases. Significant differences were found for the incidence of visual acuity impairment, ptosis and extraocular musle impairment in anterior orbitotomy and lateral orbitotomy.4. Follow-up:1007patients relapse in38cases. Adenoid cystic carcinoma recurrence rate was the highest (27.9%), followed by varix (11.9%) and inflammatory pseudotumor (6.3%). This study compared the recurrence rate of anterior orbitotomy and lateral orbitotomy, and no statistical significance was found (P>0.05).ConclusionConsiderations for selection of orbit surgical methods should include the location and biological characteristics of tumor. Anterior orbitotomy indications are no longer confined to the anterior orbital tumor, even for part of the tumor lesions involving the deep orbital it also can obtain good effect.