Anatomic evaluation of endoscopic transnasal transorbital approach to the lateral orbital apex.
BACKGROUND
This anatomic study investigates the feasibility of an endoscopic transnasal transorbital approach to the lateral orbital apex.


METHODS
Five cadavers with no prior history of sinus surgery were studied bilaterally. Standard techniques and instrumentation for functional endoscopic sinus surgery were used to perform dissections and delineate anatomy of sinuses and orbits.


RESULTS
With resection of the inferior aspect of the lamina papyracea and the medial portion of the orbital floor, followed by incision of the periorbita along the inferomedial aspect of the orbit and removal of minimal orbital fat, a satisfactory view of the surgical field is achieved. The medial and inferior rectus muscles are dissected and retracted to allow visualization of the optic nerve. By dissecting inferior to the optic nerve and using 0 and 30° endoscopes, the lateral orbital apex could be accessed without damage to the optic nerve.


CONCLUSIONS
In patients whose vision is irreparably damaged, one might consider an endoscopic approach to lesions of the lateral orbital apex. Approach in patients with intact vision should be handled with caution because of possible traction of the optic nerve.
Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, Saint Louis, Missouri, USA.
Bianca
B
Kenyon
Jastin L
JL
Antisdel
D002102:Cadaver; D004210:Dissection / Q000379:methods*; D019723:Endoscopes; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000033:anatomy & histology / Q000601:surgery; D009900:Optic Nerve / Q000033:anatomy & histology / Q000601:surgery; D009915:Orbit / Q000033:anatomy & histology / Q000601:surgery*; D010256:Paranasal Sinuses / Q000033:anatomy & histology / Q000601:surgery*