Anterior orbitotomy for suspected rhabdomyosarcoma
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This is Richard Allen at the University of Iowa. This video demonstrates biopsy of a suspected rhabdomyosarcoma in a child. The patient has a superior-medial orbital mass. A lid crease incision has been marked and will be made with the 15 blade. The incision is made through the skin and orbicularis muscle. The orbital septum is then identified and dissection is performed in order to expose the orbital septum. This dissection is performed superiorly between the orbicularis muscle and the orbital septum for exposure. The preaponeurotic fat is then visible posterior to the septum. The orbital septum is then opened and the preaponeurotic fat is identified. The fat is then elevated and the mass is visualized medially. A 4-0 silk suture is placed through the upper lid at the level of the tarsus for traction. Blunt dissection is then performed around the mass with the Freer periosteal elevator. An attempt is made to remove as much of the mass as possible. This is performed with the capsule intact if possible, however in this case it is performed in a piecemeal fashion. I think there is evidence that debulking as much of the lesion as possible is advantageous. However, this should not be performed if significant complication would be risked. Additional portions of the tumor are identified and excised. Again, I would not risk ptosis or diplopia since these patients usually respond relatively well to radiation and chemotherapy. After hemostasis is assured, the lid crease incision can then be closed. This is performed with interrupted 5-0 fast-absorbing sutures. At the conclusion of the case, erythromycin ophthalmic ointment is placed over the incision. The patient will use the ointment 3 times a day for a week.