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Alexander Knezevic, Michael Mbagwu, Hans Barron Heymann, Sarah Eichinger, Preeti Thyparampil, Paul Bryar; Differences in surgical approach and tissue yield in adult orbital lesion biopsies. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5623.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of this study is to evaluate the preferred surgical approach used by different surgical services in the biopsy of adult orbital lesions.
A retrospective chart review was conducted using the Northwestern Enterprise Data Warehouse for all adult patients having undergone orbital biopsies from January 2000 to October 2014. 104 orbital biopsies with histopathologic diagnoses (103 patients) were identified.
The surgical services responsible for biopsy were oculoplastics (82.7%), ENT (6.7%), combined oculoplastics and ENT (4.8%), plastic surgery (2.9%), neurosurgery (1.9%), and general ophthalmology (1%). 45.2% (47/104) of the biopsies were excisional and 54.8% (57/104) were incisional biopsies. Skin based lid incisions were most utilized, 70% (77/110), followed by non-skin based lid incisions, 16% (18/110), orbital access via bone dissection, 5% (6/110), endoscopic, 5% (5/110), combined approach, 3% (3/110), and exenteration, 1% (1/110). Of the incisional biopsies, skin based lid incisions had an average biopsy size of 1.04 cm^3, non-skin based lid incisions had a biopsy size of 0.47 cm^3, and orbital access via bone dissection had an average biopsy size of 0.24 cm^3 (p=0.73353). The most commonly used specific surgical approaches were: superior lid crease by oculoplastics (43%, 37/86), endoscopic (29%, 2/7) and sublabial incisions (29%, 2/7) by ENT, endoscopic with a non-skin lid incision (40%, 2/5) for combined cases, skin incisions by plastic surgery (100%, 3/3), craniotomy by neurosurgery (100%, 2/2), and transconjunctival by ophthalmology (100%, 1/1).
The oculoplastics service performed the largest number of orbital biopsies at a large urban academic center. Each surgical service had a preferred biopsy approach. Skin based lid incisions were most commonly used, and there was not a significant difference in incisional biopsy size between surgical approaches.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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