Purpose: 

To examine the necessity for lateral osteotomy for intact removal of tumors within the orbital lobe of the lacrimal gland.

Methods: 

Patients who, between 1992 and 2020, were scheduled for intact excision of well-defined masses within the orbital lobe of the lacrimal gland were identified from an orbital database. A retrospective review of the clinical records was performed and details of the tumor size obtained from histopathological reports. The first patients in the series had lateral osteotomy, whereas later, there was a shift toward osteotomy-free tumor excision through a skin-crease incision. The latter approach required isolation of the gland’s orbital lobe on an intact sheet of periosteum, an anterior “flip” of the mass (out of the orbit, past the orbital rim) “hinged” at the isthmus between the orbital and palpebral lobes, and finally a division of the isthmus to release the intact mass.

Results: 

Clinical details were available for 100 patients (50 male), with 56 tumors removed using lateral osteotomy and 44 without. The mean age at surgery was 50.3 years with osteotomy (median, 51.8; range, 19–85 years) and 51.1 years without (median, 50.3; range, 11–81 years; P = 0.81). There were no postoperative complications in either group. Although the range of tumor volumes was similar in the two groups (1.6–15.0 ml with osteotomy; 0.9–15.1 ml without), the average volume was somewhat greater in those having osteotomy (mean, 6.4 ml) as compared with those without (mean, 4.6 ml; P = 0.0016). Inadvertent rupture of the tumor occurred once in each group, with tumors of similar small size.

Conclusions: 

In many cases, large masses within the orbital lobe of the lacrimal gland can be safely removed intact, using the described flip technique without the need for lateral wall osteotomy.

中文翻译：

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完整切除泪腺眶叶肿瘤，有或无外侧壁截骨术

目的： 

检查侧截骨术以完整切除泪腺眶叶内肿瘤的必要性。

方法： 

从眼眶数据库中确定了 1992 年至 2020 年间计划完整切除泪腺眶叶内明确肿块的患者。对临床记录进行回顾性审查，并从组织病理学报告中获得肿瘤大小的详细信息。该系列中的第一批患者进行了侧向截骨术，而后来，通过皮肤折痕切口向无截骨术的肿瘤切除转变。后一种方法需要将腺体的眶叶隔离在一张完整的骨膜上，肿块的前部“翻转”（离开轨道，经过眶缘）“铰接”在眶叶和睑叶之间的峡部，以及最后分裂地峡以释放完整的质量。

结果： 

100 名患者（50 名男性）的临床详细信息可用，其中 56 名使用侧向截骨术切除肿瘤，44 名未使用。截骨手术的平均年龄为 50.3 岁（中位数为 51.8；范围为 19-85 岁），无截骨手术的平均年龄为 51.1 岁（中位数为 50.3；范围为 11-81 岁；P = 0.81）。两组均未出现术后并发症。尽管两组的肿瘤体积范围相似（截骨术为 1.6-15.0 ml；未截骨术为 0.9-15.1 ml），但与未行截骨术的患者（平均 6.4 ml）相比，接受截骨术的患者的平均体积稍大（平均, 4.6 毫升; P = 0.0016)。每组均发生一次肿瘤意外破裂，肿瘤体积较小。

结论： 

在许多情况下，泪腺眶叶内的大块肿块可以安全地完整切除，使用所描述的翻转技术，无需外侧壁截骨术。