PMC4131493_01
PMC4131493_02
Preoperative lesion.
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fig1
On clinical examination the growth extended superoinferiorly from supraorbital ridge to ipsilateral alae of nose and mesiodistally from right inner canthus of eye to left side of maxillary buttress crossing midline (Figure 1).
Axial CT scan.
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fig2
The axial and coronal sections showed large homogenous mass covering the whole left orbit involving the globe but no erosive damage was seen in any of the bony structures (Figure 2).
Photomicrograph (H & E stain 20x).
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fig3
Incisional biopsy was performed and histopathological report revealed dermal invasion by abnormal cells from the epidermis, pleomorphism of the tumour cells with presence of keratinization within the cells which give the cells abundant pink cytoplasm, and intraepithelial keratin in the shape of a whorl which confirmed the diagnosis of squamous cell carcinoma of lower eyelid involving the whole of the eye (Figure 3).
Wide excision of tumor.
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fig4
The patient was intubated using orotracheal intubation; skin incision was marked around the tumour leaving 1 cm of healthy looking skin all around which was quite a daunting task looking at the size of the tumor (Figure 4).
Postexcision.
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fig5
As the tumour was engulfing the whole of the globe as well as retrobulbar contents with the due consultation with the ophthalmologist, complete orbital exenteration was performed (Figure 5).
Temporalis muscle flap transpositioned.
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fig6
Next the pedicled temporalis muscle flap was harvested and was transpositioned medially onto left side of orbit and sutured with skin over the bridge of the nose (Figure 6).
Skin graft.
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fig7
Split thickness skin graft was harvested from anteromedial side of left thigh approximately 4 x 3 inches and placed over the temporalis muscle flap (Figure 7).
PMC4131493_03
Postoperative healing.
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fig8
The patient is in follow-up for the past 10 months with no signs of recurrence or discomfort (Figure 8).