Beveled Osteotomies in Lateral Orbitotomy Using a Customized Rotating Bone Saw for Orbital Neoplasms

This study aims to develop a novel method of beveled osteotomy for lateral orbitotomy using a customized 21-mm stainless steel rotating saw in lateral orbitotomy and to evaluate the outcome of a novel beveled osteotomy in lateral orbitotomy. This article presents a case series (19 orbits from 18 patients) of lateral orbitotomies for excision biopsy of orbital neoplasms, over a 10-year period (from September 2001 to October 2011). It is a retrospective observational study. The surgeries were performed under the primary service of one surgeon (M. D. D. S.), the author of this study. All patients were treated via beveled osteotomies in lateral orbitotomy using a stainless steel, 21 mm diameter, customized rotating bone saw. Preoperative and postoperative measurements were tabulated and statistically analyzed. The case series demonstrated that beveled osteotomies in lateral orbitotomy using a stainless steel, 21 mm diameter, customized rotating bone saw was technically possible and provided access to lateral subperiorbital, peripheral, and central surgical spaces. The exposure was ample for excision biopsy of all neoplasms in this study. No patient needed the use of miniplate hardware in repositioning the lateral orbital wall nor complained of a palpable deformity of the lateral orbital wall. The wound healing was rapid, with minimal tissue distortion or scars. There were two patients who developed skin burns, but neither required a cosmetic surgery to correct scarring from the burn. It was concluded that the modified technique of beveled osteotomies in lateral orbitotomy provides excellent access to the lateral subperiorbital, peripheral and central surgical spaces. The exposure was adequate for excision biopsy of all neoplasms in this study. The technique promotes osseous union without the use of miniplate hardware. The use of a stainless steel 21 mm diameter customized rotating bone saw facilitated the successful outcome of the beveled technique.

A Clinical Update and Radiologic Review of Pediatric Orbital and Ocular Tumors

While pediatric orbital tumors are most often managed in tertiary care centers, clinicians should be aware of the signs of intraocular and orbital neoplasms. In the pediatric population, a delay in diagnosis of orbital and intraocular lesions, even if benign, can lead to vision loss and deformity. Intraocular lesions reviewed are retinoblastoma, medulloepithelioma, and retinal astrocytic hamartoma. Orbital neoplasms reviewed are rhabdomyosarcoma, neuroblastoma metastases, optic pathway glioma, plexiform neurofibroma, leukemia, lymphoprolipherative disease, orbital inflammatory syndrome, dermoid and epidermoid inclusion cysts, and Langerhans’ cell histiocytosis. Vascular lesions reviewed are infantile hemangioma and venous lymphatic malformation. In conjunction with clinical examination, high-resolution ophthalmic imaging and radiologic imaging play an important role in making a diagnosis and differentiating between benign and likely malignant processes. The radiologic imaging characteristics of these lesions will be discussed to facilitate prompt diagnosis and treatment. The current treatment modalities and management of tumors will also be reviewed.