Comparative Techniques of Medial Rectus Muscle Retraction for Endoscopic Exposure of the Medial Intraconal Space

Lin, Guojian; Freitag, Suzanne K.; Kocharyan, Arminé; Yoon, Michael K.; Lefebvre, Daniel R.; Bleier, Benjamin S.

doi:10.2500/ajra.2016.30.4307

Cited by 21 publications

(25 citation statements)

References 21 publications

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“…Access to the medial intraconal orbit has posed great challenges, and different approaches have been described including medial orbitotomy and transconjunctival approaches . The endoscopic endonasal approach provides a direct route to the medial orbit, making this the preferred approach among endoscopic skull base surgeons . Some advantages include lack of external incisions, no brain retraction, no displacement of orbital structures including the globe, no need for reconstruction when ocular muscle detachment is not performed, and shorter hospitalization time .…”

Section: Discussionmentioning

confidence: 99%

“…It requires extensively trained surgeons because 3‐dimensionl (3D) perception of the orbit can be difficult. Depending on the histology type, stage, or grade of some lesions, an additional open approach may also be necessary …”

Section: Discussionmentioning

confidence: 99%

“…The corridor between the inferior and medial recti muscles creates the ideal route to access the inferomedial intraconal orbit . Different maneuvers to increase entry into this space and generate stability due to the extreme mobility of the orbital structures have been described (Table ) . External retraction of the medial and inferior rectus muscles was also described by McKinney et al .…”

Section: Discussionmentioning

confidence: 99%

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Analysis of anterior and posterior maneuvers to enhance intraconal exposure

Lemos-Rodriguez

Farzal

Overton

et al. 2018

Int Forum Allergy Rhinol

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Background:The medial and inferior recti encompass the ideal surgical corridor to approach the intraconal space endonasally. Here, we describe 3 different maneuvers to achieve greater access to orbital contents through an expanded endonasal approach (EEA). Methods:Four human cadaver heads were dissected bilaterally (n = 8). EEA to the medial intraconal orbit was executed. The following 3 maneuvers were performed: (1) anterior: extraocular muscles control (EOM); (2) posterior: annulus of Zinn (AZ) release; and (3) anterior/posterior combined. Measurements of the inferior and medial rectus corridor at the level of anterior ethmoidal artery (AEA) and posterior ethmoidal artery (PEA) and extent of optic nerve and medial rectus visualization was performed before and a er each maneuver.Results: Medial rectus length (MRL) and optic nerve length (ONL) achieved were 1.72 ± 0.28 cm and 0.85 ± 0.2 cm, respectively. Mean caudal-rostral distances between the rectus muscles at the level of the AEA and PEA were 3.45 ± 0.7 mm and 1.30 ± 0.3 mm, respectively. A er EOM control, mean caudal-rostral distances at the same level were as follows: AEA 4.90 ± 1.15 mm (p = 0.009) and PEA 1.70 ± 0.20 mm (p = 0.016). With AZ release, MRL was 2.20 ± 0.7 cm (p = 0.002) and ONL was 1.30 ± 0.2 cm (p = 0.003), with mean rostral-caudal distance at the level of AEA at 4.03 ± 0.8 mm (p = 0.16) and PEA at 1.71 ± 0.36 mm (p = 0.039). Mean caudal-rostral distances achieved with AZ release and EOM control were as follows: AEA 5.6 ± 1.2 mm (p = 0.001) and PEA 2.15 ± 0.4 mm (p = 0.001). Conclusion:Progressive access to the orbital contents is afforded with the 3 delineated maneuvers. The magnitude of access is optimized with the combined maneuver. The actual anterior/posterior location of the target will determine which maneuvers are required. C 2018 ARS-AAOA, LLC. Key Words: orbital/ocular; endoscopy; endoscopic minimally invasive surgery of the skull base; FESS; endoscopic skull base surgery How to Cite this Article: Lemos-Rodriguez AM, Farzal Z, Overton LJ, et al. Analysis of anterior and posterior maneuvers to enhance intraconal exposure. Int Forum Allergy Rhinol. 2019;9:556-561. E ndoscopic endonasal approaches have evolved through the years, from the resection of pituitary and transsellar

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Analysis of anterior and posterior maneuvers to enhance intraconal exposure

Lemos-Rodriguez

Farzal

Overton

et al. 2018

Int Forum Allergy Rhinol

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“…In these cases we use a middle and inferior muscle retraction as McKinney et al [3] recommended with good results. Nevertheless there are other alternate techniques for controlling the rectus muscles: using a special instrument (double ball instrument), transeptal retraction, transchoanal retraction or detachment [17] of medial rectus muscle opening the medial orbit like a book with medial rectus pedicled on the annulus of Zinn [3].…”

Section: Exposure Of the Medial Intraconal Spacementioning

confidence: 99%

Endonasal Endoscopic Approach for Primary and Secondary Orbital Lesions

Garcia¹,

Pérez²,

Perdomo³

et al. 2017

J Clin Exp Ophthalmol

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Purpose: To describe the results of endonasal endoscopic resection for primary and secondary orbital lesions.Design: A retrospective cohort study was performed. Subjects:The clinical data of patients with primary and secondary orbital tumors who received treatment with endonasal endoscopic surgery from Agost 2016 to July 2017 in the Department of Head and Neck Surgery of the National Institute of Oncology and Radiobiology (Cuba) were analysed.Intervention: All surgeries were performed by using Karl Storz 00, 450 and 700, 4 mm diameter; 18 cm rod-lens rigid telescopes (Karl Storz and Co, Tuttlingen, Germany). Endonasal endoscopic transethmoidal route was the primary approach, and according to the tumor size, histology and location, a transantral route was aggregate. Main outcome measures:Demographic data, histology nature of the lesions, clinical presentation, surgical route, frozen section margins and complications relative to treatment were obtained. Grade of resection was measured.Results: From total of 12 patients that were interview, 7 were male and 5 female. Age range was 20-70 years and a mean age of 50.2 years. According to nature of the lesions, seven patients have malignant neoplasm and three patients have non-neoplasic disorders. Transethmoidal route was performed in 4 patients and transethmoidal/ transantral in 8 patients. Total resection was achieved in 11 patients (92%). Frozen section margins were negative in all patients. All patients experienced complete resolution of the presenting symptoms with no evidence of optic nerve injury. Two patients presented transient ophtalmoparesis. Conclusion:Endonasal endoscopic surgery is a safe, successful and minimally invasive technique for resecting extra-intraconal primary and secondary orbital tumors; especially those arise posterior to the ocular glove and inferomedially of optic nerve. There are some important key points to take account in order to prevent complications.

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“…Lin et al, 14 from the Massachusetts Eye and Ear Infirmary, compared varying techniques of medial rectus muscle retraction for endoscopic exposure of the medial intraconal space. This article is extremely valuable given the rapidly advancing field of endoscopic…”

mentioning

confidence: 99%

Immunorhinology and Rhinosinusitis: Where are we Heading?

Sacks

2016

Am J Rhinol�Allergy

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Immunorhinology and rhinosinusitis: Where are we heading? O ver the past 2 decades, multiple etiologic options have been published as to the cause of chronic rhinosinusitis (CRS). We have had excellent documents that relate to microbiologic organisms, including viruses, bacteria, and fungi. These have taken the form of a multitude of different pathologic entities, including immunologic response to fungi and bacteria, staph exotoxin, and bacterial biofilm, and, more recently, the importance of the microbiome. However, we are still left without any single etiologic factor involved in the development of CRS. This edition of the American Journal of Rhinology and Allergy has a number of extremely fascinating themes.The first theme is aimed at highlighting the sinonasal microbiome in CRS and potential factors in the stimulation of the inflammatory process. Anderson et al. 1 performed a systematic review of the sinonasal microbiome in CRS, and their findings indicated that, in fact, there is no clear single causative microbe. There was significant heterogeneity throughout their studied articles, with firmicutes, Actinobacteria, and bacteroides being identified in both the controls and the patients with CRS. There is clearly much more research required to fully define the role that the microbiome plays in CRS. In terms of factors that influence the inflammatory cycle, Shimizu et al. 2 presented a fascinating article that looked at the role that alarmins play in the pathogenesis of upper airway inflammation. They specifically looked at alarmin protein high mobility group box 1 (HMGB1). With sound methodology, they found significantly higher concentrations of HMGB1 in nasal secretions from patients with CRSwNP or with allergic rhinitis (AR) compared with the control. They noted that TNF-␣ stimulated the production of HMGB1, which, in turn, upregulated the production and secretion of interleukins 6 and 8, which indicated that HMGB1 does in fact play an important role in the pathogenesis of upper airway inflammation.Lee et al. 3 looked at the role of a number of cytokines in the nasal epithelium of patients with AR, and they showed that a decreased expression of epithelial junctional protein was found in patients with AR, with disruption of epithelial integrity via interleukins 4 and 5, and TNF-␣, which indicated a possible role in the pathogenesis of AR. There also are valuable data from Shun et al., 4 who evaluated the role that hypoxia plays in the formation of nasal polyposis by promoting autophagy in nasal polyp fibroblasts. The autophagy seems to be suppressed in hypoxia through the antiglycolytic activity of SIRT6, which is shown to be beneficial to nasal polyp formation. There are significant potential therapeutic benefits in the management of nasal polyposis if glucose metabolism through a SIRT6-based strategy can be found to be modulated.AR has long fascinated researchers and clinicians. The relationship between AR and asthma is well known. It, therefore, was interesting to see the article from Dogru 5 that showed ...

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Comparative Techniques of Medial Rectus Muscle Retraction for Endoscopic Exposure of the Medial Intraconal Space

Cited by 21 publications

References 21 publications

Analysis of anterior and posterior maneuvers to enhance intraconal exposure

Analysis of anterior and posterior maneuvers to enhance intraconal exposure

Endonasal Endoscopic Approach for Primary and Secondary Orbital Lesions

Immunorhinology and Rhinosinusitis: Where are we Heading?

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