Anterior orbitotomy for rhabdomyosarcoma
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This is Richard Allen at the University of Iowa. This video demonstrates an anterior orbitotomy in a 7 year old patient with suspected rhabdomyosarcoma. The mass is in the inferior lateral quadrant of the orbit. A 4-0 Silk suture is placed through the eyelid margin at the level of the meibomian gland orifices to provide traction during the case. A needle tip cautery is then used to make a transconjunctival incision inferior to the inferior border of the tarsus, extending from the lateral canthus laterally to the punctum medially. Dissection is then carried out between the orbicularis muscle and the orbital septum to the inferior orbital rim. The mass is palpated posterior to the orbital septum. A 4-0 Silk suture is then placed through the cut end of the conjunctiva and lower lid retractors to provide traction. The mass is identified. Hemostasis is obtained with the bipolar cautery. There is some evidence that removal of as much of a rhabdomyosarcoma as possible is advantageous. This is performed with a combination of the freer periosteal elevator and front biting forceps. The tissue was sent to the pathologist which confirmed our suspicions of a rhabdomyosarcoma, embryonal type. Additional tumor is excised and the conjunctiva is closed with interrupted 7-0 Vicryl sutures.