Sequential oculoplastic reconstruction in an irradiated field after resection of large NF1-associated orbital MPNST: a case report.

We report a 25-year-old male who underwent en bloc resection of a large NF1-associated high-grade malignant peripheral nerve sheath tumor (MPNST) and oculoplastic reconstruction. Following adjuvant chemo-radiotherapy and 3 years of oncologic surveillance, sequential oculoplastic refinements were performed to address radiation-induced periorbital and facial fibrosis, ptosis, and volume loss. These included brow lift, ptosis repair, blepharoplasty, lateral canthal lengthening, and autologous fat grafting. At one-year follow-up after reconstruction: symmetrical palpebral fissures (30 mm OD, 31 mm OS), bilateral MRD1 of 5 mm, no lagophthalmos, FACE-Q scores improved from 25/100 to 85/100, and MRI confirmed 70% fat graft retention with no tumor recurrence. A structured, stepwise approach to immediate functional stabilization, adjuvant therapy, and surveillance, followed by sequential functional and aesthetic refinements, may help guide reconstructive planning in similarly complex cases.