Orbital Surgery for orbital tumor, principel and methods, approach

Because of the orbit’s confined space and proximity to critical neurovascular structures, orbital surgery must follow five core principles to ensure both safe tumor resection and postoperative outcomes.

 

 

 

🔹 5 Principles of Orbital Surgery

1. Select the Closest and Safest Approach
    - Route should provide proximity and minimize collateral damage
    - Choose anatomically safe zones; bilateral access if needed
2. Ensure Adequate Surgical Exposure
    - Wide incision is essential
    - Use local epinephrine injection and maintain hemostasis
3. Approach from Normal to Pathologic Tissue
    - Favor blunt dissection
    - Sacrifice minimal normal tissue for en bloc resection if necessary
    - For cysts, leave margin to avoid rupture
4. Avoid Aggressive Maneuvers
    - Especially in orbital apex where optic nerve and muscles are at risk
    - Avoid blind dissection behind tumors
5. Postoperative Monitoring and Management
    - Watch for retrobulbar hemorrhage: check vision, IOP, pupil
    - Use ultrasound/CT promptly
    - Drain insertion (Vacuum drain) when high-risk
    - Do not over-suture the wound tightly → avoid pressure buildup

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📋 5 Principles of Orbital Surgery Summary Table (English)

PrincipleKey PointPractical Tip

1	Use closest, safest approach	Bilateral access if needed for space
2	Ensure clear field	Wide incision, epinephrine, thorough hemostasis
3	From normal → lesion; blunt dissection preferred	Sacrifice tissue margin for complete excision
4	Avoid blind/aggressive maneuvers	Avoid optic nerve or EOM damage
5	Strict postoperative care	Monitor retrobulbar hemorrhage, drain if necessary