title: Endoscopic transmaxillary transMüller's muscle approach for decompression of superior orbital fissure: a cadaveric study with illustrative case.
abstract: BACKGROUND
  In an effort to avoid the damage and inconvenience associated with transcranial approaches, we developed an endoscopic transmaxillary transMüller's muscle approach for decompression of the superior orbital fissure (SOF).
  
  
  METHODS
  The endoscopic transmaxillary transMüller's muscle route was performed in ten cadaveric heads. We measured important anatomic landmarks, and angles radiographically. This approach was initially attempted in one patient with traumatic superior orbital fissure syndrome (tSOFS).
  
  
  RESULTS
  A maxillary antrostomy was carried out with a buccal sulcus incision. The sinus ostium and the course of infraorbital nerve were used as endoscopic anatomic landmarks. Then the inferior orbital fissure was drilled out, followed by separating the Müller's muscle. The periorbita were peeled off from the lateral wall, followed by the endoscope going along the periorbital space, until the lateral aspect of the SOF could be visualized. Decompression was successfully performed in all specimens. The initial clinical application justified this approach. The patient had an uneventful postoperative course and satisfactory recovery.
  
  
  CONCLUSIONS
  This approach offers sufficient endoscopic visualization and reliable decompression of SOF. It avoids the need for brain retraction, temporalis muscle manipulation, or any external incision, and appears to be able to deliver satisfying aesthetic results as well as favourable functional recovery.
authors.affiliation: Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China.
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China. Electronic address: huang64@163.com.
authors.forename: Cheng-Guang
authors.initials: CG
authors.lastname: Huang
authors.affiliation: Department of Radiology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China.
authors.forename: Hong-Chao
authors.initials: HC
authors.lastname: Liu
authors.affiliation: Department of Radiology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China.
authors.forename: Qing-Chu
authors.initials: QC
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China.
authors.forename: Ming-Kun
authors.initials: MK
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China. Electronic address: lj_hou@hotmail.com.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Hou
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks / Q000033:anatomy & histology; D002102:Cadaver; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D004172:Diplopia / Q000601:surgery; D004210:Dissection / Q000295:instrumentation / Q000379:methods; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006987:Hypesthesia / Q000601:surgery; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008443:Maxillary Sinus / Q000033:anatomy & histology / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061330:Multidetector Computed Tomography / Q000379:methods; D009130:Muscle, Smooth / Q000033:anatomy & histology; D009295:Nasal Bone / Q000033:anatomy & histology; D009915:Orbit / Q000033:anatomy & histology / Q000294:innervation / Q000601:surgery*; D009917:Orbital Fractures / Q000601:surgery*; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function / Q000502:physiology
keywords: Endoscope; Müller's muscle; Superior orbital fissure; Traumatic superior orbital fissure syndrome