Extended Orbital Exenteration: A Step-by-Step Approach

Extended orbital exenteration is a highly disfiguring operation which entails complete removal of the orbital contents including periorbita, eyelids and involved surrounding bony walls with variations tailored to the specific clinical circumstances. The aim of such an extensive surgery is to achieve local control of the life-threatening progressive neoplasms, when other treatment modalities fail to achieve disease control. Eyelids can be preserved in posterior orbital pathology, while it may not be possible in neoplasms arising from the anterior eye tissues. Depending on the clinical circumstances, if the neoplasm is invading the surrounding bony orbit, the involved bony and soft tissue structures are removed en bloc to achieve complete resection (R0 resection). Although the steps of the orbital exenteration are well defined, the same is not true for extended orbital exenteration. We demonstrate the details of extended orbital exenteration in different clinical scenarios for the malignancy of orbit and periorbital tissues invading surrounding orbital walls.