65110 Exenteration of orbit (does not include skin graft), removal of orbital contents; only

Name of the Procedure:

Exenteration of orbit (does not include skin graft), removal of orbital contents

Summary

Exenteration of the orbit is a surgical procedure where the contents of the eye socket, including the eye itself, are completely removed. This does not involve the removal of surrounding skin or the application of a skin graft.

Purpose

This procedure addresses severe eye conditions such as malignant tumors, life-threatening infections, or severe trauma to the eye area. The goal is to remove all diseased tissue to prevent the spread of infection or cancer and to alleviate pain.

Indications

• Ocular malignancies like retinoblastoma or melanoma.
• Severe ocular infections that do not respond to treatment.
• Trauma to the eye and surrounding structures.
• Blind, painful eyes secondary to various conditions.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Pre-surgical blood tests and imaging studies like CT or MRI scans of the orbit.
• Discussion of current medications and possible adjustments.
• Thorough medical history review.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision to access the orbit.
3. All orbital contents, including the eyeball and associated tissues, are carefully removed.
4. Hemostasis is achieved to control bleeding.
5. The incision is closed with sutures.
6. A pressure dressing may be applied to reduce swelling and aid healing.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

The procedure is performed in a hospital's surgical operating room.

Personnel

• Ophthalmic surgeon
• Surgical nurses
• Anesthesiologist
• Operating room technicians

Risks and Complications

• Bleeding
• Infection
• Damage to surrounding structures
• Adverse reactions to anesthesia
• Need for further reconstructive surgery
• Cosmetic concerns

Benefits

• Removal of diseased tissue and prevention of further spread.
• Improvement or resolution of pain.
• Potentially lifesaving in cases of malignancy or severe infection.

Recovery

• Hospital stay for monitoring, typically 1-3 days.
• Pain management with prescribed medications.
• Instructions to keep the area clean and dry.
• Follow-up appointments for wound assessment.
• Complete recovery may take several weeks to months, depending on overall health and complexity of the case.

Alternatives

• Enucleation or evisceration: less extensive procedures which might be suitable in less severe cases.
• Radiation or chemotherapy: for certain ocular tumors.
• Symptomatic treatment: for non-malignant, less severe cases.

Patient Experience

• Patients will be under general anesthesia and will not feel pain during the procedure.
• Postoperatively, patients may experience discomfort, which will be managed with pain medications.
• Swelling and bruising are common immediately after surgery.
• Psychological support may be beneficial due to the significant nature of the surgery.