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Surgical Treatment of Orbital Tumors

There are various types of tumors or lesions that can occur around or behind the eye. Orbital surgery is often required to identify and biopsy the lesion for further treatment. Such tumors or lesions can be benign (such as hemangiomas or cysts) or malignant (such as lymphomas or metastatic tumors) or even be inflammatory in nature. Dr. Zoumalan has undergone extensive training to perform orbital surgery and to manage such conditions.

orbitalmass OS side profile

This patient presented with a large orbital tumor behind his eye. It was resulting in discomfort and worsening double vision. A CT scan demonstrated a large orbital tumor. An orbital surgery was performed (termed orbitotomy) to remove the tumor which was a hemangioma (benign tumor composed of blood vessels). His double vision improved and his left eye returned back to a more normal position.

This patient above had a slow growing tumor growing within her right sinus and orbit resulting in double vision, proptosis (bulging out of eye), and pain. You can note that the right eye is displaced superiorally due to the mass effect of the tumor below the eye. This is resulting in the eye to «be pushed upward» and resulting in double vision.

Her CT scan shows a large cyst-like lesion that occupies the maxillary sinus and also invading the orbit. The arrows mark the superior and inferior extent of the tumor. The tumor has invaded through vital structures; as a result, she has no orbital floor present (no bone to allow the eye to rest on) and no midfacial bones (missing cheekbones). She will need surgical repair to reconstruct the orbit and midface once the tumor/lesion is removed successfully.

postopnormalleft sagittal
This CT shows you what a normal CT of the maxillary sinus and orbit should look like. This was taken from her left (unaffected and healthy) side.

This is 2 months after she underwent complete excision of cyst and reconstruction of the orbital and midface using bone grafting and titanium plates. The bone grafting was required to reconstruct her missing bone along the orbital floor, rim, and midface and allow for replacement of the skeletal volume she had lost as a direct result of the tumor’s effects. She underwent endoscopic and open removal of the tumor through sinus, oral, and eyelid incisions, none of which you can see in this photograph since the incisions are cosmetically appealing and well-hidden. Note that both eyes are now in the same plane. As a result, her proptosis is gone and so is her double vision and pain.

This is a postoperative CT scan showing the orbital and midfacial reconstruction that the patient had. The cyst was completely removed and the orbital floor, orbital rim, and midface were reconstructed using calvarial bone graft (bone taken from her own skull) and titanium plates and meshes. Note how close to similarity this now looks to the healthy, unaffected side in the figure above.

This is a 3D CT Reconstruction showing the extend of reconstruction that was performed on the right orbit floor (see the mesh), orbital rim (note the titanium plates) and the remaining midface (mesh and plates).

Left lower lid orbital tumor. Note that the bulge is herniating through the left lower lid. The tumor was removed through a transconjunctival approach (same incision used for cosmetic eyelid surgery) and completely excised.

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