A combined facial, orbital and intracranial resection of extensive basal cell carcinoma arising in the eyelid.

We report a single stage en bloc surgical excision and repair of extensive recurrent basal cell carcinoma arising in the eyelids. It combines the advantages of an en bloc dissection, direct visual evaluation of intracranial extension and immediate reconstruction. A team of surgeons, ophthalmic plastic, neurologic, and plastic, employed both an anterior facial and intracranial approach to excise the tumor.

Isolated neurofibroma of the orbit.

In a 66-year-old woman, a large solitary neurofibroma arising in the right infraorbital nerve extended into the maxillary antrum and the orbit. Following extirpation of this rare tumor, bony defects of the right orbital floor and inferior orbital rim were repaired with a biplanar supramid implant.

Traumatic enophthalmos.

Traumatic enophthalmos, either following orbital floor fracture or enucleation, is caused by decreased orbital volume. Volume replacement, both surgical and/or nonsurgical, provides a direct treatment. Surgical treatment can increase orbital volume by reducing the herniated orbital tissue and/or implanting alloplastic or autogenous material. When a seeing eye is present, implant surgery may compromise vision; volume replacement must be judicious. Alternative surgical management creates the illusion that little or no enophthalmos exists by enlarging the palpebral fissure or changing orbital contour.