Anterior Craniofacial Resection for mebomain Gland Cancer Involving The Eye-A Rare Case

A 60-year-old man presented with a history of swelling in the left eye of 6 months duration that was gradually progressive and painless initially. Later he developed pain, yellowish discharge, and bleeding from the lesion.

On examination, the patient had an exophytic growth in the left upper eye extending horizontally from the medial canthus to the lateral canthus. The swelling extended vertically from upper eye lid margin to the lateral aspect of the lower fornix. The tumour involved lower eyelid, eyeball, conjunctiva and extra-ocular muscles. The upper and lower lid margins were distorted (Figure 1). There was loss of vision in left eye with no perception of light. On examination of the neck, there was an enlargement of firm, mobile 1* 1 cm sized left level II node.

A biopsy was done outside that revealed Squamous cell carcinoma. Magnetic resonance imaging of the orbits was done which showed well-defined soft tissue intensity lesion in the superolateral part of conal -intraconal compartment of the left orbit. There was questionable bone erosion, but no orbital apex involvement or intracranial extension. There were few enlarged right level II and parotid nodes. The patient underwent an anterior craniofacial resection, orbital exenteration, partial (supra-structure) maxillectomy, superficial parotidectomy, functional neck dissection (type 3 modified radical neck dissection) by Dr. Vishal Choksi (H&N Cancer Surgeon) and Dr. Deepak Malhotra (neurosurgeon) and reconstruction with a microvasular anterolateral thigh flap and skin graft by Dr. Harshwardhan Sahajwani and Dr Pramod Menon.

He had an uneventful post-operative course and was discharged on the 5th day after surgery. The histopathology report was suggestive of a Mebomian gland carcinoma of the left eyelid sized 5*4*3.5 cm involving periorbital soft tissue with lymphovascular an the perineural invasion with positive intra-parotid lymph nod*'f hepatient re ived adjuvant radiotherapy. He has been regularly followed up every monthly for the f t 3 month"nftver weeks for the next 6 months. He is doing well with no evidence of disease.