Orbital exenteration is a radical surgical procedure involving the removal of the eye and associated structures within the orbit. It is typically reserved for severe cases of malignancies or infections that are unresponsive to other treatments. This procedure, while life-saving, results in significant disfigurement and functional impairment.

The indications for orbital exenteration are increasingly debatable, but it remains the treatment of choice in the management of malignant tumors of the orbit or neighboring tumors with intraorbital extensions, and more rarely, severe infections of the face [1,2].

Basal cell carcinomas of the eyelids are the leading cause of orbital exenterations, followed by squamous cell carcinomas, retinoblastomas and orbital melanomas. [3], orbital exenteration can be categorized into several types, including lid and conjunctiva sparing anterior exenteration, lid sparing anterior exenteration, total exenteration, and extended exenteration, the choice of exenteration type is tailored to the patient's specific condition and the extent of the disease [4].

Reconstruction of the exenteration cavity is variable, with multiple techniques available, the choice of which depends on the surgical team, the extent of the exenteration and the exposure of noble elements, notably the dura mater, which requires immediate coverage. In addition to the patient's general condition, the most commonly used muscle flap is the temporalis muscle flap, which fills the residual cavity, allowing neo-adjuvant radiotherapy to be performed in a timely manner if indicated. [5] directed healing is still possible with plugging from the residual bone this technique allows easier prosthetic rehabilitation and easier oncological monitoring but delays adjuvant radiotherapy and prolongs the convalescence period [6].

The small number of cases in the published series of exenteration procedures, together with the great heterogeneity of malignant tumours in terms of histology, location and operators: oculoplasticians, ENT and maxillofacial surgeons, makes it difficult to compare the efficacy of exenteration with that of conservative treatment..

A metanalysis published in 2016 showed a survival rate after orbital exenteration for a malignant tumor showeda time to median (50%) survival for all patients was 78.4 months. The 1-year survival rate was 93.4% and the 5-year survival rate was 54.1%. Although not statistically significant, notable differences were found in the interval to death with respect to the identification of perineural invasion, lymphovascular invasion, and histopathologic features. The review of published studies suggested a difference in the histologic features and location of the disorder treated, the extent of  orbital exenteration undertaken, and the method of reconstruction between the ophthalmology and nonophthalmology surgical disciplines [7] orbital exenteration remains the surgical technique that provides optimal control of the cancerous disease, thus avoiding local recurrence. [8,9], systemic survival after orbital exenteration compared with conservative treatment studies show no difference [10] but no randomized controlled study has been conducted in this area, given the rare nature of orbital exenteration.

The emergence of targeted therapies for cutaneous carcinomas [11] and melanomas is set to revolutionize the management of these tumors and may make it possible to adopt more conservative approaches ( eye-sparing ) and avoid exenteration, which is disfiguring surgery [12,13].

Currently, most surgical teams recommend prosthetic reconstruction for morphological reasons and for better monitoring of recurrence [14], except that in cases of enlarged exenteration with exposure of the meninges or deep structures of the face, a filling with a muscle flap seems well suited, since it completes the treatment with radiotherapy if indicated within 6 weeks [11]. In our series, most cases were reconstructed using a muscle flap, for two reasons: firstly, the extent of the excision, and secondly, the patient's socio-economic status, which does not allow for expensive prosthetic rehabilitation.

From our point of view, orbital exenteration still retains its place in the therapeutic protocol, provided that the therapeutic decision is taken on the basis of clinical, radiological and histological arguments in a specialized centre and during a multidisciplinary consultation meeting, and with the patient's consent. Orbital exenteration has shown its efficacy in ensuring optimal local tumour control, facilitating follow-up and morphological rehabilitation, and improving patients' quality of life.