title: Three-wall decompression technique using transpalpebral and endonasal approach in patients with Graves' ophthalmopathy.
abstract: OBJECTIVE
  To evaluate the effects of the three-wall decompression technique using transpalpebral and endonasal approach in patients suffering from Graves' ophthalmopathy.
  
  
  METHODS
  In this prospective study, we present a consecutive series of 15 subjects (17 eyes) who were submitted to orbital decompression by removing the inferior and lateral walls using transpalpebral incision combined with a transnasal endoscopic resection of the medial wall. The surgical technique involved the preservation of the bone structure between the lamina papyracea of the ethmoid and the maxillary orbital floor.
  
  
  RESULTS
  The mean ocular recession based on Hertel measurements was 6.00 mm (range, 4-9 mm). None of the patients presented pre-operation diplopia, and one developed post-operation diplopia. Visual acuity was preserved in all cases.
  
  
  CONCLUSIONS
  It is safe and efficient to perform three-wall decompression, combining transpalpebral and endoscopic transnasal approach, with preservation of the bone structure and the bone lateral to the infraorbital canal with fixation by two titanium plates on the lateral edge and removal of intraorbital fat, which results in significant proptosis reduction and minimal complications.
authors.affiliation: Department of Plastic Surgery, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brasil. pezatobau@ig.com.br
authors.forename: Rogério
authors.initials: R
authors.lastname: Pezato
authors.forename: Max Domingues
authors.initials: MD
authors.lastname: Pereira
authors.forename: Paulo Gois
authors.initials: PG
authors.lastname: Manso
authors.forename: Rodrigo de Paula
authors.initials: Rde P
authors.lastname: Santos
authors.forename: Lydia Masako
authors.initials: LM
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005094:Exophthalmos / Q000601:surgery*; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity