Exenteration of orbit (does not include skin graft), removal of orbital contents; with muscle or myocutaneous flap
CPT4 code
Name of the Procedure:
Exenteration of Orbit (does not include skin graft), Removal of Orbital Contents with Muscle or Myocutaneous Flap
Summary
Exenteration of the orbit is a surgical procedure that involves removing the contents of the eye socket, including the eye, muscles, and other tissues. This particular procedure involves covering the exposed area with a muscle or myocutaneous flap rather than a skin graft.
Purpose
The procedure is typically performed to treat severe eye conditions, such as malignant tumors, severe infections, or life-threatening trauma. The goal is to remove diseased tissue to prevent the spread of cancer or infection, alleviate pain, and reduce other symptoms.
Indications
- Malignant tumors (e.g., orbital cancers)
- Severe orbital infections
- Traumatic injuries to the eye socket
- Failed previous surgeries
Suitable patients usually exhibit one or more of these conditions and have not responded well to less invasive treatments.
Preparation
- Fasting for at least 8 hours before the surgery
- Adjustments or cessation of certain medications (as advised by the physician)
- Preoperative diagnostic tests such as CT scans, MRIs, and blood tests
- Appointment with the anesthesiologist to discuss sedation options
Procedure Description
- Administration of general anesthesia to ensure the patient is unconscious and pain-free.
- A surgical incision is made around the orbit to access the eye socket.
- All orbital contents, including the eye, muscles, and tissues, are carefully removed.
- A muscle or myocutaneous flap is harvested from the patient's own tissue.
- The flap is then positioned and secured to cover the exposed area.
- The incision is closed with sutures, and sterile dressings are applied.
Specialized surgical tools and imaging equipment are used throughout the procedure.
Duration
The procedure typically takes between 2 to 4 hours, depending on the complexity.
Setting
This surgery is usually performed in a hospital operating room.
Personnel
- Ophthalmic surgeon
- Anesthesiologist
- Surgical nurses
- Support staff (e.g., surgical techs)
Risks and Complications
- Common risks: infection, bleeding, and scarring
- Rare risks: damage to adjacent structures, flap failure, and anesthesia-related complications
- Potential management includes antibiotics for infections, additional surgery for bleeding or scarring, and specialized care for anesthesia issues.
Benefits
- Removal of diseased or damaged tissue
- Potential pain relief and improved quality of life
- Prevention of further spread of infection or cancer
Benefits can often be realized soon after recovery.
Recovery
- Patients typically stay in the hospital for a few days post-surgery
- Follow-up appointments to monitor healing and assess for complications
- Instructions on wound care and activity restrictions
- A recovery period of several weeks to months
- Patients may require additional reconstructive surgeries or prosthetics
Alternatives
- Less invasive surgical options (if feasible)
- Radiation or chemotherapy for certain cancers
- Conservative management with medications for infections
Alternatives are considered based on their effectiveness in comparison to the extensive removal of tissues that exenteration provides.
Patient Experience
- Patients will be under general anesthesia during the procedure, so they will not feel any pain.
- Postoperatively, there may be discomfort or pain managed with prescribed medications.
- Emotional and psychological support may be necessary due to the significant impact of the procedure on body image and functionality.
- Vision loss in the operated eye is permanent, requiring adjustments and rehabilitation.
Pain management and comfort measures are explicitly planned by healthcare providers to ensure a smoother recovery.