Radical Orbital Exenteration with Temporalis Muscle Flap Reconstruction for Advanced Basosquamous Carcinoma of the Lower Eyelid
Author: Novella Montericcio
Base Hospital / Institution: Humanitas University Hospital
ePoster presentation
Abstract ID: 25-582
Purpose
To present a complex case of basosquamous carcinoma of the right lower eyelid with orbital invasion, managed through exenteration and reconstructive surgery.
Methods
A 51-year-old male with basosquamous carcinoma (cT4aN0) of the right lower eyelid underwent contrast-enhanced CT revealing deep orbital invasion without distant spread. Surgery involved a right periorbital skin incision, maintaining ~1.5 cm of macroscopically healthy tissue. A pedicled temporalis myocutaneous flap was harvested after zygomatic bone sectioning to allow orbital rotation. The orbital rim was skeletonized, and orbital contents were exenterated en bloc, including lateral and inferior walls. Intraoperative frozen sections (apex, maxillary sinus mucosa, lateral orbital periosteum) were tumor-free. Due to intraoperative CSF leakage, autologous fat from the left lower abdomen was harvested and, after Tachosil overlay application, used to obliterate the cavity. The temporalis flap was rotated into position, and a Tiersch dermoepidermal graft from the left thigh was applied to the flap donor site. Layered closure and compressive dressings completed the procedure.
Results
Histopathology confirmed an infiltrative ulcerated basosquamous carcinoma involving the orbit, sparing the bone. Intraoperative frozen sections of margins were tumor-free. No perioperative complications occurred, and the patient demonstrated good healing of graft and flap donor sites.
Conclusion
This case underscores the importance of comprehensive radiological and histopathological assessment in advanced periocular malignancies. Radical surgical excision combined with autologous flap and graft reconstruction remains the cornerstone of treatment in extensive local disease to achieve oncological control and preserve anatomical integrity.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Giovanni | Ottonelli | Humanitas University Hospital |
| Alessandra | Di Maria | Humanitas University Hospital |
