The Clinical Assessment Of Lateral Orbitotomy By Kr(?)nlein-Berke In Surgical Treatment Of Intraorbital Tumors

The approach of lateral orbitotomy by Kr?nlein-Berkecan't injury the important structures of eye easily, the boneflap is easy to be accomplished, and the surgical vision iswide enough to explore the whole fossa orbitalis. It is thecommonly used method adopted by oculists of removingintraorbital tumors. To study the surgical method of lateralorbitotomy, observe the clinical curative effect, analysis thecomplications, we have retrospectively evaluated the recordsof 29 patients with intraorbital tumors hospitalized at theThird Medical Hospital of Ji Lin University from 1984March to 2003 October. Among them, 14 patients werefemale and 15 were male. The mean age was 44 years,ranging from 11 to 74 years. The left orbit was affected in14 cases and the right one in 15 cases. No case showedbilateral involvement. The number of lesions in eachhistopathologic classification and distribution were asfollows: cavernous hamangioma(11), epithelial tumor oflacrimal gland(4, benign 3, malignant 1), inflammatorypseudotumor(4), dermoid cyst(2), neuroinoma (2),adenocarcinoma of lacrimal gland(2), intraorbitalmelanoma(1), vascular leiomyoma(1), pseudolymphoma(1)and myoschwannoma(1). Examinations of eyes before thesurgery were as follows: Exophthalmos degree ≤2mm were 4cases, among 3~6mm were 17 cases, >6mm.were 8 cases.Visual acuity ≥0.8 were 19 cases, among 0.8~0.3 were 6cases, among 0.3~0.05 were 2 cases,<0.05 were 2 cases. Allthe patients were operated under general anaesthesia,performed the Kr?nlein-Berke lateral orbitotomy. Mainobjects of the surgery are to remove tumors, improvesymptom, elevate visual acuity and recover appearance. Weshould choose the surgical approach according to theposition, nature and extension of tumors. In theretrospectively evaluation we find 27 patients werecompletely removed, and 2 mostly removed. These two weredermoid cyst and intraorbital melanoma. We foundintraoperative that the dermoid cyst was 4×4×4cm3, itssuperior, temporal or inferior reached to bone wall, nosalreached to retrobulbar. It was hard to avoid injuringextraocular muscles or nerve when pursuing completeremoval. The intraorbital melanoma destroyed orbital wallseriously, we removed the tumors in sight in doubt that it hasmetastasized or diffused, and supplemented with drugs aftersurgery. There was prominent improvement in exophthalmosafter lateral orbitotomy, the number of patients ofexophthalmos between 1~2mm raised from 4 to 24, deal withstatistics, P<0.0005. But there were 5 patients still remainedmore than 3mm, the histopathologic classification of themwere as follows: adenocarcinoma of lacrimal gland,cavernous hamangioma, neuroinoma, vascular leiomyoma,and intraorbital melanoma. The cavernous hamangiomaremained tumor about 0.9 cm2 in nosal position approved bycomputer tomography after surgery, in our observation thatwas the reason of remaining exophthalmos. The othersremained exophthalmos in our opinion that was because ofstrong tissue response and bleeding after surgery. There wasno prominent improvement in visual acuity, 3 patientsimproved ≥2 lines, 18 patients ≤1 line, 8 patients decreased≥2 lines or lost. Deal with statistics, 0.05>P>0.02.Complications of orbitotomy in visual injury, dyskinesia ofeyeball, ptosis and corectasis are often encountered. Therewere 2 patients lost their visual acuity after lateralorbitotomy, they both were neuroinoma, 8 patientscomplicated with different degree of dyskinesia, 3 patientsptosis, 4 patients corectasis. There is obvious relationshipbetween complications of orbitotomy and surgical approach.We should operate orbit through the nearest approach to thetumors, less important anatomic structures of orbit.Recurrence has main relationship with surgery manipulationand the nature of tumors. Imageological examinations areimportant to surgery in judging the position and nature ofintraorbital tumors, choosing proper approach of orbitotomy,estimating prognisis. B-scan ultrasonography, CT and MRIare often used. To gain accurately diagnosed preoperatively,we should choose different radiological method according todifferent position and nature of tumors, or unite two or threeof them.