Surgical exposure of lateral orbital lesions using a coronal scalp flap and lateral orbitozygomatic approach: clinical experience.
BACKGROUND
The lateral extraconal compartment is a typical localization of intra-orbital tumours. With the exception of anterior lesions, which can be reached by a transconjuntival route, most of these tumours are currently approached through the classic lateral orbitotomy originally described by Kronlein. We present here our experience in the management of lateral orbital lesions, using a coronal skin flap, followed by subfascial dissection of the temporalis muscle. The procedure was intended to overcome the potential drawbacks associated with the classic transtemporal approach.


METHODS
The approach was used in eleven patients harbouring bone lesions of the lateral orbital wall or intra-orbital lesion of the lateral extra-ocular compartment. The postoperative results were assessed using a simple cosmetic outcome scale, which evalutated the temporalis muscle trophism and the function of the frontotemporal branch of the facial nerve.


RESULTS
All lesions were satisfactorily exposed. The subfascial dissection of the temporalis muscle is a key manoeuvre which, at the same time, abolishes the risk of injury to the frontotemporal branch of the facial nerve and provides a wide exposure of the lateral orbital wall. The cosmetic outcome was excellent in 9 patients and good in 2 patients.


CONCLUSIONS
The reported technique is a convenient surgical option to approach lateral intra-orbital lesions, with a minimal cosmetic impact.
Paolini
S
S
Università degli Studi di Perugia, Cattedra di Neurochirurgia - IRCCS Neuromed, Pozzilli, Italy. spao2@yahoo.com
Santoro
A
A
Missori
P
P
Pichierri
A
A
Esposito
V
V
Ciappetta
P
P
D000328:Adult; D000368:Aged; D020220:Facial Nerve Injuries / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D005624:Frontal Bone / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D009918:Orbital Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013524:Surgical Flaps / Q000592:standards*; D013703:Temporal Muscle / Q000033:anatomy & histology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015050:Zygoma / Q000033:anatomy & histology / Q000601:surgery*