Evaluation of Transconjunctival Approach in Management of Orbital Tumors

Study Overview
=================
Brief Summary
-----------------
Many surgical approaches for excision of orbital tumors have been described. These approaches do not allow access to all orbital quadrants. Furthermore, some of these approaches are technically difficult, associated with long morbidity and post operative pain, having high rate of complications or having unacceptable cosmetic appearance. the investigators present the transconjunctival approach as an alternative procedure that allows access to orbital tumors in different locations as well as less morbidity and better cosmetic results

Detailed Description
-----------------
Orbital tumors are divided anatomically into intraconal and extraconal depending on their relationship with the muscle cone which is further classified into anterior and posterior orbital tumors. Excision of orbital tumors is considered a challenge for the surgeon. This is due to the complex structure of the orbit. The orbital cavity is narrow that does not allow adequate exposure. Furthermore, the orbit is full of vital structures which require careful manipulation. Many surgical approaches for excision of these tumors have been described. These approaches do not allow access to all orbital quadrants. Furthermore, some of these approaches are technically difficult, associated with long morbidity and post operative pain due to the osteotomy, having high rate of complications or having unacceptable cosmetic appearance. Few studies with limited number of patients have used transconjunctival approach in management of orbital tumors All patients with orbital tumor will be managed by the transconjunctival incisional or excisional biopsy according to the suggested nature of the tumor being benign or malignant as well as the site of the tumor using the clinicoradiological finding. In case of intraconal tumors, the mass will be approached via the transconjunctival approach but if the mass is out of reach via this approach, lateral orbitotomy approach will be used as an alternative procedure to perform the predetermined decision. This allows detection of the intraconal tumor criteria that could be excised safely via this approach

Official Title
-----------------
Evaluation of Transconjunctival Approach in Management of Orbital Tumors

Conditions
-----------------
Orbital Tumors

Intervention / Treatment
-----------------
* Procedure: transconjunctival orbitotomy approach


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients with orbital tumor either benign or malignant. Exclusion Criteria: Patients with apical tumors not accessible with transconjunctival approach. Patients with too anterior tumors (superficial dermoid and lacrimal gland swelling). Patients with non-neoplastic orbital lesions. Patients with follow up period of less than 3 months
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Incisional or excisional biopsy of orbital tumors via transconjunctival approach
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: patients with orbital tumors<br>patients with orbital tumors will be managed by excisional or incisional biopsy via the transconjunctival orbitotomy approach | Procedure: transconjunctival orbitotomy approach<br>* approach the orbital tumor through an incision in the conjunctiva, This is followed by blunt dissection of the tenons capsule. A traction suture is applied over the corresponding rectus muscle to guide the globe toward the desired direction. The orbital fat is retracted by malleable retractor and blunt dissection through the orbital connective tissue continues until reaching the edge of the tumor. After the mass is exposed, a biopsy or complete resection of the mass is taken place<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| successfulness of the surgical procedure | The procedure will be considered successful if the predetermined decision is achieved without sight threatening complications. The procedure will be considered a failure if the decision could not be achieved or if a sight threatening complication occurs. | every patient will be assessed 3 days postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Early and late complications of the approach and their long term effects | the assessment will include intraoperative or postoperative complications. the complication will be followed up for up to three months to determine if the complication is self limited (example: self limited lid edema or subconjunctival hemorrhage) or has a long term effect (example: permanent visual loss or permanent limited ocular motility) | 3 days postoperative, 1 week, 1 month and 3 months postoperative. | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
orbital tumors, transconjunctival approach