**11. Orbital exenteration with superior orbital margin/frontal bone removal**

The patient presented with adenoid cystic carcinoma of the right lacrimal gland (**Figure 43**). Contrast enhanced CT scan coronal and axial view reveals soft tissue mass in the upper lateral and superior orbit with outward and medial displacement of the eye ball (**Figure 44A** and **B**). Three dimensional reconstruction reveals erosion of the superior orbital rim and outer plate of the frontal bone without any intracranial extension (**Figure 45**). Such a case in addition to the orbital exenteration will need lateral and superior orbitectomy. Skin incision and periosteum exposure were performed as described for the first case. The periosteum on the superior rim was removed widely to encompass the involved area and achieve negative margins of resection. After orbital exenteration the lateral and the superior orbital

*Extended Orbital Exenteration: A Step-by-Step Approach DOI: http://dx.doi.org/10.5772/intechopen.104763*

**Figure 43.** *This patient has an adenoid-cystic carcinoma of the right lacrimal gland.*

#### **Figure 44.**

*(A) A contrast-enhanced coronal view of CT scan shows the tumor involving the superior and lateral orbit with displacement of the globe. (B) A contrast-enhanced axial view of CT scan shows the tumor involving the orbit.*

#### **Figure 45.**

*3-D reconstruction revealed erosion of the orbital rim and outer plate of the frontal bone.*

wall or cranial base was drilled generously to expose dura completely to ensure even the microscopic tumor is removed. The skull base area to be resected is shown in the **Figure 46A** and **B**. The Bone drilling is done well beyond the grossly involved margin and dura exposed (**Figure 47**). To hasten the process Kerrison's punch can be used to remove the thinned out bone. Since this is an eyelid sparing procedure, surgical defect is repaired with closure of the remnant eyelid flaps.

#### **Figure 46.**

*(A) Anterior view of the planned bone cuts outlined on a skull. (B) Right lateral view of the planned bone cuts outlined on a skull.*

#### **Figure 47.**

*The surgical defect shows the complete removal of the superior and lateral wall of the orbit and exposed dura (arrow).*
