title: Endoscopic orbital floor decompression with preservation of the inferomedial strut.
abstract: BACKGROUND
  Medial and inferior orbital decompression is most commonly performed in the setting of dysthyroid orbitopathy. Diplopia represents the most common complication and may be minimized through the preservation of a bony inferomedial strut (IMS). Historically, this has required a transconjunctival approach due to the technical demands of performing an isolated orbital floor decompression using endoscopic instrumentation. Here we describe a novel technique of a purely endoscopic orbital floor decompression with reliable preservation of the IMS.
  
  
  METHODS
  Description of a novel surgical technique for endoscopic orbital floor decompression with IMS preservation using frontal sinus instrumentation visualized by a 70-degree endoscope.
  
  
  RESULTS
  We have successfully used this technique in 12 orbits with 100% preservation of the bony inferomedial strut and no complications. The extent of decompression and width of the residual strut may be fine tuned as needed to optimize results.
  
  
  CONCLUSIONS
  Orbital floor decompression with IMS preservation may be reliably performed using purely endoscopic techniques. Successful completion of this procedure requires the adaptation of standard frontal sinus instrumentation to the maxillary sinus roof and thus may be readily mastered by any endoscopic surgeon comfortable with frontal sinus techniques.
authors.affiliation: Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Bleier
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Lefebvre
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Freitag
mesh_terms: D019299:Decompression, Surgical / Q000379:methods*; D004172:Diplopia / Q000517:prevention & control; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D008443:Maxillary Sinus / Q000601:surgery; D009915:Orbit / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D016896:Treatment Outcome
keywords: diplopia; endoscopic orbital floor decompression; inferomedial orbital strut; orbital decompression