total orbital excision

Content removal is a necessary treatment for malignant tumors. For the malignant and benign lesions of the eyelids, in order to save lives, relieve pain, improve appearance, and sometimes need to remove the content. Total sputum removal includes eyeballs, intraorbital soft tissue and periosteum, sometimes including removal of the eyelids. The scope of the resection depends on where the lesion is involved and whether or not to retain the skin. Of course, if the tumor has invaded the eyebrow, the eyebrow should be removed. With the continuous improvement of modern treatment methods, the indications for the removal of all-in-one content are also changing. For example, lacrimal gland malignant tumors have been the indications for the removal of total sputum content. However, in some cases, on the basis of extensive local resection, combined with postoperative radiotherapy, the same effect as sputum excision can still be obtained. Curing disease: Indication Full-content removal is available for: 1. Orbital and conjunctival malignant tumors. 2. Intraocular malignant tumors spread inside the sputum. 3. Primary malignant tumors in the sputum are not effective for radiotherapy or chemotherapy. 4. Recurrent or multiple recurrent benign tumors, such as optic nerve meningioma, lacrimal gland pleomorphic adenoma, fibrous histiocytoma. 5. Palliative therapy for metastatic cancer in the sputum. 6. Sinus malignant tumor invasion and intraorbital chemotherapy or radiotherapy are invalid. 7. Other lesions, such as inflammatory pseudotumor loss of vision, unable to control due to pain. 8. Mold infection, when drug treatment is ineffective or life-threatening. Surgical procedure 1. Surgical sputum content removal according to different lesions and different surgical methods: 1 preserved eyelid and conjunctival sputum content removal: external sacral incision 1cm, flip upper and lower squat, with long shear from the upper sac The conjunctiva of the upper edge and the lower edge of the lower tarsal plate is separated into the medial condyle, and the conjunctiva is cut and the ends of the upper and lower incisions are connected at the medial condyle. Separate along the front of the septum to the gingival margin, suture the upper and lower palpebral conjunctival stumps, and wrap the eyeball. 2 Do not retain the full eyelid removal of the eyelids: suture the cleft palate, cut the skin and subcutaneous tissue along the temporal margin, cut the periosteum along the gingival margin, separate it into the periosteum, and remove the sputum content. 3 Retaining the eyelid skin content removal: cut the skin and rim muscle along the upper and lower sacral gray line 360°, and merge the incision in the lateral and medial condyles. Separation from the rim muscle to the iliac crest for sputum removal. The skin of the medial malleolus is relatively tight, and the incision should be careful not to remove the skin of the skin. 2. The periosteum and the iliac crest were separated and the skin was exposed to the periosteum. The periosteum was cut 360° along the gingival margin with a round knife. The exfoliation was started along the upper quadrant of the iliac crest. The bone wall was flat and easy to peel off. Separate from the periosteum to the tip of the iliac crest, strip the upper quadrant of the nose, and use a knife to cut the tougher trochlear. In the internal and external iliac crest, close to the bone wall to cut the iliac crest and lateral ligament. The nasal side wall is thin and the operation is gentle. When separating from the supracondylar fissure and the inferior tibiofibular fissure, use scissors to cut the sacral fissure tissue (because of the sacral fissure and the sacral content near the infraorbital fissure and the adhesion of the bone wall), and separate the sputum content under the periosteum to make all Content is free. When the inner wall is separated, the trochle, the supraorbital nerve, the anterior and posterior arteries, etc. are all required to be cut off after electrocautery. During the separation process, the inner wall is most likely to be broken by pressure or separation and should be carefully peeled off. The direction of the stripper should always be perpendicular to the inner wall, and the inner wall can be perforated by being separated slightly inward. Since the whole sputum content is removed, there is no soft tissue in the sputum. Therefore, after the sinus and the sinus cavity communicate with each other, it is easy to cause intra-orbital infection or sinus-sinus paralysis. 3. Remove the sputum content as far as possible to separate the sputum content, use the tissue clamp to clamp the sputum content tissue and pull up, use the meninges to cut the sputum between the bone wall and the periosteum from the inside or outside of the sacral tip. After removing the contents, carefully check the tip of the sputum. If there is still residual tumor tissue, it should be completely removed. If it is normal soft tissue, it can be retained. When the content of the sputum is removed, the bleeding of the eye artery is fiercer and should be coagulated after clamping. The hemorrhoids of the apex and upper and lower iliac crests also need to be coagulated. Fill the saline gauze in the cavity and press to stop bleeding. When cutting the content tissue from the outside to the inside, do not press the inside pressure, otherwise the inner wall may be easily broken. If the lesion has invaded the apex of the sputum, the soft tissue should be completely removed when the sputum is removed, and the sputum should be burned to remove the residual tissue. The soft tissue of the apex can be removed to the front of the optic canal, but attention should be paid to the bleeding of the ophthalmic artery. The removal of the supracondylar or inferior palpebral fissure should also be thorough. If the bone wall is invaded after removal of the sputum, the bone wall should be removed to the normal bone or completely removed to the adjacent structure to reach the intracranial or concave. Another thing to be aware of is to remove the lacrimal sac and close the nasolacrimal duct. 4. Disposal of the sacral cavity After the removal of the contents, there are various methods for the treatment of the sacral cavity: 1 Skin grafting: Regardless of whether or not the eyelid is preserved, the sacral skin grafting is a good method for keeping the sacral cavity dry quickly. The inner side of the left femur (the right side is not conducive to cutting the skin piece) is 6cm × 7cm (the middle part of the skin is cut into several small mouths for drainage), implanted on the wall of the iliac cavity, and the skin is sutured intermittently with the upper and lower iliac crest. The Vaseline gauze is evenly filled in the cavity to adhere the skin and the sacral flap to the sac wall, and the pressure bandage is applied. The use of tomographic skin has the advantage of rapid healing. After the general removal of the sputum, the dressing of the sacral cavity is 7 to 10 days later. At this point, most of the sacral skin has survived. Premature dressing is not conducive to skin growth. 2 Natural epithelialization of the sacral cavity: The sacral cavity is not skin grafted, so that the granulation tissue is naturally formed in the sacral cavity, the sacral cavity is shallow, the surface is smooth and epithelialized, and the process takes several months. This method is suitable for the removal of the sputum content without retaining the eyelids. The disadvantage is that it requires a long-term dressing change. 3 : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : When suturing, first make 2 to 3 pairs of sutures, and then suture the cleft palate. A drainage strip can also be placed in the iliac crest on the outside of the iliac crest, and taken out 48 hours after the operation. In the short-term, there is a large amount of exudate in the sacral cavity, and the subcutaneous cavity of the subcutaneous cavity is liquid fluctuation. Generally, the liquid gradually absorbs after a few weeks, and the eyelid skin is sagged into the sac. This method is suitable for patients with lesions invading the conjunctiva or tarsal plate and not invading the skin. This method is simple, but it is difficult to shape the eyelids due to the absence of the eyelid structure. In the short-term CT scan, there is a effusion in the sacral cavity. The late fluid is gradually absorbed and replaced by fibrous tissue, accounting for 1/3 to 1/2 of the depth of the sacral cavity. If a filling such as glass is placed in the cavity, CT can be clearly displayed. 5. Others In the treatment of lacrimal gland malignancies, the sputum content removal surgery generally includes a bone wall resection of the lacrimal gland, and the inner wall of the iliac crest is removed when the lacrimal sac is invaded. When the sinus malignant tumor invades the iliac crest, the maxilla and the ethmoid bone are removed; but the resected cavity is filled with tissue.

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