Name of the Procedure:

Orbitotomy with bone flap or window, lateral approach (e.g., Kroenlein); with removal of lesion

Summary

Orbitotomy with a bone flap, also known as the Kroenlein procedure, involves surgical access to the orbit (eye socket) through the side of the skull. This technique is used to remove a lesion or abnormal growth within the orbit.

Purpose

This procedure is performed to address conditions involving lesions or abnormal growths within the orbit, such as tumors, cysts, or infections. The goal is to remove the lesion, alleviate symptoms, and prevent further complications, such as vision loss.

Indications

• Presence of an orbital tumor or cyst
• Unexplained swelling or mass in the orbital region
• Vision changes or loss caused by a lesion
• Pain or discomfort due to an orbital growth

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to current medications might be necessary (e.g., blood thinners).
• Pre-operative imaging studies, such as CT or MRI scans, to assess the lesion and plan the surgery.

Procedure Description

1. The patient is administered anesthesia (typically general anesthesia).
2. An incision is made in the lateral aspect (side) of the skull near the orbit.
3. A bone flap or window is carefully created to access the orbit.
4. The lesion is identified and meticulously removed.
5. The bone flap is repositioned and secured, and the incision is closed with sutures or staples.
6. Wound dressings are applied, and the patient is moved to recovery.

Duration

The procedure typically takes 2-3 hours, depending on the complexity and size of the lesion.

Setting

Performed in a hospital operating room or a surgical center equipped for complex surgeries.

Personnel

• Ophthalmologic or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Damage to surrounding structures, including vision loss
• Scarring or cosmetic changes
• Reactions to anesthesia

Benefits

• Removal of the lesion, alleviating symptoms and preventing further complications
• Potential improvement or preservation of vision
• Relief from discomfort or pain

Recovery

• Patients typically stay in the hospital for 1-2 days for monitoring.
• Instructions include wound care, activity restrictions, and pain management.
• Follow-up appointments to monitor healing and ensure proper recovery.
• Full recovery can take several weeks to a few months, depending on individual healing and the complexity of the surgery.

Alternatives

• Non-surgical options may include observation, medication, or less invasive procedures if the lesion is small or not causing severe symptoms.
• Radiation therapy for certain types of tumors.
• Each alternative has its own risks and benefits, which should be discussed with a healthcare provider.

Patient Experience

• Patients will be under general anesthesia during the procedure and will not feel pain.
• Post-operative discomfort managed with pain medication.
• Swelling, bruising, and temporary vision changes may occur, gradually improving over time.