Orbital reconstruction after exenteration: use of a transorbital temporal muscle flap

Orbital exenteration is a disfiguring operation that involves the total removal of the orbital contents with partial or total excision of the eyelids. Common methods of orbit reconstruction include pectoralis musculocutaneous pedicled flap and free tissue transfer. The purpose of this study is to illustrate that the entire temporalis muscle may be used by creating a large window in the lateral orbit, without resection of the lateral orbital rim. Orbital exenteration was performed on four cadavers. A window was created in the lateral orbit using a 4-mm pineapple burr. Three parameters were measured: (1) the distance between the zygomatic arch to the superior aspect of the temporalis muscle; (2) the width of the temporalis muscle; and (3) the length and width of the lateral orbit window. The free edge of the transposed temporal muscle was then sutured to the skin edge around the bony orbit. This procedure was then performed on a 73-year-old man who had undergone right orbital exenteration for ocular melanoma and then postoperative radiation. The dimensions of the bony windows in the cadavers were as follows: mean 3.3 cm (SD +/- 0.19 cm) x 1.9 cm (SD +/- 0.18 cm), n = 4. The dimensions of the temporalis muscle in the cadavers were the following: mean 8.45 cm (SD +/- 0.60 cm) x 10.5 cm (SD +/- 0.33 cm), n = 4. In the patient, the size of the bony window was 3.7 cm x 2.1 cm (n = 1), and the dimensions of the temporalis muscle were 8.1 cm x 10.2 cm (n = 1). The patient recovered well without complication, with a well-healed skin graft over the top of the muscle flap. An adequate bony window can be made to allow transfer of the entire temporalis muscle for orbital reconstruction without resecting the lateral orbital rim or entering the middle cranial fossa. This option is a good alternative to the other commonly performed methods of orbital reconstruction because of its completion in one operative stage, short operative time, and minimal donor site morbidity.