Purpose of review Lateral orbital wall decompression is one of many well established techniques available to surgeons in management of patients with clinically significant thyroid eye disease (TED). Several different surgical approaches have been described in the literature and are reviewed herein. Recent findings Lateral orbital wall decompression remains a popular technique for surgical management of TED, with a recent American Society of Ophthalmic Plastic and Reconstructive Surgery survey showing that 22.6% of respondents preferred a single-wall procedure, with 36.8% of that subset preferring lateral wall decompression alone. Surgical techniques for lateral orbital wall decompression differ based on several steps, such as the incisional approach, whether to take an ab-interno versus ab-externo approach, and whether to remove orbital fat to achieve further decompression. In addition, technological advances have produced an array of tools available to the orbital surgeon to achieve efficient and accurate bone removal. Summary Lateral orbital wall decompression for TED, despite being an older technique, remains a popular and well established procedure for orbital decompression. Though no randomized controlled clinical trial supports one decompression technique over another for TED, lateral orbital wall decompression offers many benefits such as its ease of access and visualization of the orbital space.
involvement was noted in 11 patients in each branch. These data hint that arteritis may be more prevalent in the frontal branch than the parietal branch. Notably, in the majority of patients who had imaging signs of temporal arteritis, abnormalities were present in one branch but not the other, at least on one side. Although neuroimaging is not equivalent to the gold standard of histopathological analysis, this result suggests that selective involvement of a single branch of the superficial temporal artery is not rare. Bilateral temporal artery biopsy is sometimes performed to improve the chance of obtaining a positive result, especially if systemic symptoms are present. However, only a handful of patients will have a negative biopsy finding on one side and a positive biopsy finding on the other side. 5,6 If a second biopsy is contemplated, it may be more fruitful to sample the other branch of the artery on the same side rather than the same branch on the other side. In the future, surgeons should record whether they have biopsied the frontal or parietal branch so that data can be gathered to determine which branch is inflamed most frequently. This information may increase the diagnostic yield of temporal artery biopsy.
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