title: The transmaxillary endoscopic approach to the orbit.
abstract: OBJECTIVE
  In this surgical-anatomical cadaveric study we investigate the feasibility of the transmaxillary endoscopic approach to the intraorbital space. Anatomical landmarks are defined, the endoscopic view in the orbital space is studied and complications that can occur are discussed.
  
  
  METHODS
  Nine formalin-fixed heads were used to study the transmaxillary endoscopic approach to the orbit. The approach was used twice on each head (once for each maxilla). Therefore, we report our results on 18 transmaxillary intraorbital approaches. For better differentiation of anatomical structures, the veins and arteries were injected with blue and red plastic respectively in six cadaveric heads.
  
  
  RESULTS
  The transmaxillary approach enables viewing the inferior intraconal structures without endangering the infraorbital nerve and its artery and without diversion of the inferior rectus muscle. The optic nerve was visualised more easily through the approach medial to the inferior rectus muscle instead of lateral to the muscle since the ciliary nerves are in the way in the lateral approach. The combination of the approaches medial and lateral to the inferior rectus muscle allows very good identification of all important anatomical structures in the inferior intraconal space.
  
  
  CONCLUSIONS
  The transmaxillary endoscopic approach to the orbit is a useful new approach in the surgical armamentarium for orbital lesions. The overview of the inferior part of the orbit is excellent, and the lateral part of the optic nerve can be visualised. Careful anatomical dissection allows visualisation of important anatomical structures in the orbit without damaging nerves or arteries.
authors.affiliation: Department of Neurosurgery, Klinikum Duisburg, Wedau Kliniken, Zu den Rehwiesen 9-11, 47055, Duisburg, Germany. saskia.schultheiss@lycos.com
authors.forename: Saskia
authors.initials: S
authors.lastname: Schultheiß
authors.forename: Athanasios K
authors.initials: AK
authors.lastname: Petridis
authors.forename: Rashad
authors.initials: R
authors.lastname: El Habony
authors.forename: Peter
authors.initials: P
authors.lastname: Maurer
authors.forename: Martin
authors.initials: M
authors.lastname: Scholz
mesh_terms: D002102:Cadaver; D004210:Dissection; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008437:Maxilla / Q000601:surgery*; D008443:Maxillary Sinus / Q000098:blood supply / Q000294:innervation / Q000601:surgery*; D008953:Models, Anatomic; D009915:Orbit / Q000098:blood supply / Q000294:innervation / Q000601:surgery*