Three-wall decompression technique using transpalpebral and endonasal approach in patients with Graves' ophthalmopathy.
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.
Pezato
Rogério
R
Department of Plastic Surgery, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brasil. pezatobau@ig.com.br
Pereira
Max Domingues
MD
Manso
Paulo Gois
PG
Santos
Rodrigo de Paula
Rde P
Ferreira
Lydia Masako
LM
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