Surgical sectors of the orbit: using the lower fornix approach for large, medial intraconal tumors.
OBJECTIVE
The orbit can be viewed as comprising four surgical sectors, with several alternative incisions and dissection paths to each. Large tumors in the medial intraconal sector pose particular problems of access, exposure, and removal without functional compromise. We report the use of the lower fornix approach for excision of large tumors in this high-risk sector.


METHODS
The surgical technique is described. Its application to biopsy or subtotal resection of infiltrative lesions in the medial intraconal sector is noted. Its use for complete excision of solid, circumscribed lesions in this sector is presented in a retrospective, consecutive, noncomparative interventional case series of 5 large, medial intraconal cavernous hemangiomas.


RESULTS
The lower fornix approach provided adequate exposure for the goal of surgery in each case. Among the 5 patients with large, medial intraconal lesions, 4 had postoperative improvement in vision and 1 maintained his preoperative central acuity of 20/20. No patient had persistent symptomatic diplopia after surgery. Ease or difficulty of tumor dissection was related to the tenacity of apical fibrous attachments, a factor that appeared to be independent of the surgical approach.


CONCLUSIONS
The lower fornix approach to the orbit, an established technique for other indications, can be applied to the removal of large, medial intraconal tumors whose inferolateral poles protrude in the inferior surgical sector.
D000328:Adult; D005260:Female; D006392:Hemangioma, Cavernous / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009918:Orbital Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014792:Visual Acuity