gms | German Medical Science

Reconstruction of the the anatomy of the medial canthal area after tumour resection is difficult, because of its delicate composition of scin, conjunctiva, efferent tear ducts and lids and the close proximity to the paranasal sinuses.

In contrast to the radical surgical approach of orbital exenteration, a more conservative resection of the periorbit and subsequent reconstruction has become the treatment of choice in recent years. Depending on the histological type of the tumour, additional radiation or chemotherapy has to be considered. This emphasizes the need for immediate reconstruction of the defect.

Small superficial defects ot the medial canthal region can be closed primarily or with free scin grafts; more extensive defects call for fascio-cutaneous rotational or transpositional flaps from the glabellar or nasal regions. They can be combined with free grafts. For deep defects that include the complete soft tissue of the region and the bone, median and paramedian fasciocutaneous flaps from the forehead can be designed as transpositional or island flaps. If the orbital wall had to be removed, a purely fascial flap can reconstruct the nasal orbital wall and support the globe inferiorly without the use of artificial material.