Exenteration of orbit (does not include skin graft), removal of orbital contents; with therapeutic removal of bone
CPT4 code
Name of the Procedure:
Exenteration of orbit, removal of orbital contents; with therapeutic removal of bone
Summary
Exenteration of the orbit is a surgical procedure where the contents of the eye socket (orbit)—including the eye itself—are removed. This specific procedure also involves the therapeutic removal of bone but does not include skin grafting. It is typically a last-resort treatment for severe disease or trauma affecting the eye and surrounding structures.
Purpose
The procedure is primarily used to treat severe orbital tumors, extensive trauma, or life-threatening infections. The goal is to eliminate disease, alleviate pain, and prevent the spread of infection or malignancy.
Indications
- Malignant tumors of the eye or orbit.
- Severe infections that do not respond to other treatments.
- Extensive orbital trauma compromising eye and bone.
Preparation
- Pre-operative fasting (typically 8-12 hours before the procedure).
- Adjustments to current medications as advised by the healthcare provider.
- Pre-assessment tests such as blood work, imaging scans (CT, MRI), and a thorough physical examination.
Procedure Description
- Anesthesia: General anesthesia will be administered to ensure the patient is unconscious and pain-free.
- Incision: A surgical incision is made around the orbital area.
- Removal: The surgeon removes the orbital contents, including the eye tissue and surrounding structures.
- Bone Removal: Therapeutic removal of affected bone is performed to ensure complete disease eradication.
- Closure: The incision site is closed using sutures. Skin grafting is not part of this procedure.
Duration
The surgery typically takes 2-4 hours, depending on the extent of bone removal required.
Setting
The procedure is performed in a hospital or specialized surgical center with access to advanced surgical facilities.
Personnel
- Oculoplastic surgeon or oncologic surgeon.
- Anesthesiologist.
- Surgical nurses and assistants.
- Post-operative care team.
Risks and Complications
- Common risks: Infection, bleeding, and pain.
- Rare risks: Damage to surrounding structures, persistent swelling, or scarring.
- Complications: Hemorrhage, cerebrospinal fluid leak, and vision loss in the remaining eye if applicable.
Benefits
- Elimination of malignant or infected tissue.
- Relief from severe pain and discomfort.
- Prevention of disease spread.
Recovery
- Hospital stay for a few days post-surgery.
- Pain management with prescribed medications.
- Follow-up appointments to monitor healing and manage complications.
- Restrictions: Limited physical activities and careful wound care as advised.
- Recovery time: Several weeks to a few months, depending on individual cases and extent of surgery.
Alternatives
- Chemotherapy or radiotherapy for malignancies.
- Less invasive surgical options if applicable.
- Pros and cons: Alternatives may be less invasive but may not be as effective in complete disease eradication, particularly in advanced cases.
Patient Experience
- During: The patient will be under general anesthesia and will not be awake or feel pain during the procedure.
- After: Expect some pain and swelling. Pain management strategies will be in place to ensure comfort. The patient may experience emotional impact due to the significant nature of the surgery and will require support and counseling.