The orbit or the socket of the eyes is made up of seven bones; sphenoid, palatine, lacrimal, frontal, maxillary, Zygomatic and ethmoid bones. The socket protects and houses the globes and provides the passage for the third, fourth and sixth ocular nerves. Fibroosseous tumors such as fibrous dysplasia, osteogenic sarcoma, ossifying fibromas can grow on the orbital bones. Ossifying fibromas are generally benign in nature and could cause the face to swell. They are recurring tumors and may extend and invade the neighboring structures.
Though orbital tumors need to be treated by orbital surgeries, they are mostly benign in nature. Orbital tumors can occur anywhere in the orbit or even beyond it and can also grow to invade various optical cavities and vessels. If the diagnosis of the orbital tumors is done in time, with the help of orbitotomy surgeries, complete treatment is possible. But if an orbitotomy is not performed in time, it may jeopardize the vision of a patient. Generally, it can occur at any age.
Complete resection of orbital tumors is possible with the help of an orbitotomy which can be performed in a much less invasive manner. The entire structure of the eyes is made up of various complex blood vessels and nerves which are very minute and delicate. Therefore, an orbitotomy requires a very high degree of experience and skill.
Orbitotomy surgeries are performed to ensure that the vision of the patient is restored. In extreme cases, if orbitotomy is not performed in time, it can lead to complete vision loss. In some cases the eye may have to be removed from the socket to prevent any undue damage to the surrounding vascular and ocular structures. Today in India, most orbitotomy procedures are followed by reconstructive surgeries so to perform Orbitotomy either a team of top ophthalmic and plastic surgeons is involved or an oculoplastic surgeon performs an orbitotomy. Orbitotomy surgeries are now less invasive as compared to a few years ago; however, still they are complicated surgeries which require the top expertise of the best surgeon possible. Such surgeries may take a lot of time because of their complexity.
How are orbitotomy surgeries performed:-
Orbitotomy surgeries are performed depending upon the location of the tumor in the ocular structure. The orbitotomy surgeries are done to preserve the vision of the patient, no damage is inflicted on any ocular structure and complete resection of the tumor is performed. Orbitotomy surgeries can be performed by using a variety of approaches. A single approach can be used during for different surgeries or a combination of different approaches can be used in the treatment. Treatment comes down to location of the tumor and the condition of the patient. After most orbitotomy surgeries, the treatment is completed by reconstructive surgeries on the orbital area. Reconstructive surgeries are performed because the tumor may have caused asymmetry of the eyelids or some part of the skull may also have been affected. Therefore, to give complete treatment to the patient, reconstructive surgeries also are very important after orbitotomy surgeries.
If any abnormalities like double vision, unexplained swelling, tearing of the eyes, bulging eyes etc. are being observed immediately the top doctor should be consulted. Even a minor symptom could be an indication of a deeper problem and may require orbital surgeries.
After orbitotomy surgeries of any type, the best thing for a patient to do is to take ample rest and avoid undue stress on the eyes during the complete treatment duration.
Types of surgical approaches used for performing an orbitotomy:-
As mentioned above, depending upon the location of the tumor, two different approaches may be used for excision of the tumor; transorbital and the extraorbital.
Transorbital approaches are further divided into four sub-categories:-
- Medial Orbitotomy
- Lateral Orbitotomy
- Combination of medial and lateral orbitotomy
- Anterior orbitotomy with or without osteotomy- anterior Orbitotomy without osteotomy may involve superior approach for surgery from supraorbital, eyelid or subbrow incision or inferior approach from a incision in the lower eyelid, Transconjunctival approach or subciliary.
Extraorbital approach can be of two types:-
- Inferior orbital approach
- Frontotemporal approach: – This approach can be carried out with or without osteotomy.
As a general rule, orbital lesions which are located posteriorly are treated by extraorbital approach while anterior lesions are managed very proficiently by a transorbital approach. But this rule has its exceptions, because depending upon the location some posterior lesions can be reached via a transorbital approach. Apart from the location of the tumor, following factors also determine the surgical approach:-
- The goal of the surgery which can range from a biopsy to complete tumor excision.
- Size of the tumor
- Specific nature of the tumor
A superior or inferior anterior orbitotomy is performed for anterior lesions. Osteotomy is performed in addition to an Orbitotomy in case the anterosuperior lesion is large in size. An extraorbital approach is preferred for a lesion which is situated laterally however a lateral orbitotomy may be performed for posterolateral lesions. A medial orbitotomy is used for medial lesions which are small or located anteriorly. A large medial lesion or a posteriorly located medial lesion is excised by a combination of lateral and medial orbitotomy.
An inferior orbital approach is used in cases where the lesions are located between inferior rectus and optic nerve, both inferiorly and posteriorly. For medial or inferior lesions endoscopic approach can be used in- aux to orbital approach.
Lesions which are situated in the apex, optical canal or extend into cranial cavity are best managed by the frontoorbital approach. In case the lesion is large or if the optic canal needs to be drilled, an orbital osteotomy is also performed.
Posterolateral lesions or lesions of the sphenoid wing are best approached by a pterional approach which is mostly carried out without an osteotomy.
Orbitotomy surgeries and follow up treatments in India:-
As mentioned above, most orbital tumors are completely curable with little to no chance of recurrence. But this holds true only in cases in which the orbitotomy surgeries are performed on time. The best prognosis of orbitotomy surgeries are in the cases where the treatment has not been delayed. In India, almost 12000 cases of orbitotomy surgeries are taken up every year out which 30% of the cases are of children. A few decades ago cancers of the eyes were synonymous with complete vision loss however with better treatment and cancer management techniques now orbitotomy surgeries are quite successful in preserving vision and lives in India. Various super specialty hospitals for eyes are coming up in India, which have made India a favored destination for orbitotomy surgeries for foreign patients also. In India, the top hospitals now follow up the orbitotomy surgeries with reconstructive treatments also which is the best approach towards orbital tumors. Tumors of any kind can be life- altering and instead of fearing the best thing to do is to look for the best hospital and the best doctor possible in India. Stigmas attached with tumors in India are not true and people with tumors now have great life expectancy thanks to all medical treatment facilities in India. But even today in India the centre of healthcare, treatment and surgeries are cities like Mumbai and Delhi. Mostly the best cancer hospitals in India are in urban cities like Mumbai therefore more people have to come to Mumbai for getting the orbitotomy surgeries. Orbitotomy surgeries are handled well by oculoplastic surgeons like Dr. Shome who is the best oculoplastic surgeon in Mumbai. He is one of the few top surgeons of India who holds this super- specialty. He is based in Mumbai and is also consultant to many specialty hospitals in Mumbai. He says that number of cancer patients coming to Mumbai has been on a rise and this could indicate certain trends. Firstly, this throws light on the rising incidences of tumors in India and also the lack of treatment facilities in smaller cities which compels people to come to cities like Mumbai. Dr. Shome hopes to expand his surgeries and treatments out of Mumbai also and for that he played a key role in set- up of the first e- hospital of India which has its offices in Mumbai. His own top specialty chain of clinics known as The Esthetic Clinic is in Mumbai. His patients, who are not residents of Mumbai, can take online consultation from him. Dr. Debraj Shome is the best oculoplastic and facial plastic surgeon in Mumbai and hopes that top medical facilities are provided to all Indians and not just residents of Mumbai.