Endoscopic Endonasal Approach for Intra- and Extraconal Orbital Pathologies

Abstract

Endoscopic endonasal approaches offer an important alternative in the management of posterior inferomedial orbital pathology. Beginning with endoscopic orbital decompressions for Graves' disease, the endonasal corridor for the management of intra- and extraconal pathologies has continued to evolve. Endonasal removal of orbital cavernous hemangiomas is well described in the literature; however, many other benign and malignant pathologies of the medial orbit can be accessed through this approach. Advantages of the endonasal approach include improved visualization and decreased manipulation of orbital contents in the medial and posterior orbit. Additionally, for tumors that extend from the paranasal sinuses into the orbit, this corridor may be ideal for concurrent management. The current literature for this approach will be reviewed including the oncologic results, complications, limitations, and reconstructive needs along with pertinent anatomy. In addition, data from our own institution will be reviewed.

Endoscopic Two-Port Technique for Orbital Tumors, A Combined Transnasal and Sublabial Approach: A Retrospective Case Study

“…These complications occur mainly with the classic wide approach (the Caldwell-Luc procedure), which involves a large resection of the anterior wall of the maxillary sinus. However, the minimally invasive approach is typically associated with only temporary complications, such as facial hypoesthesia [7]. No complications were observed in our study.…”

“…This approach provides the shortest direct route to caudal orbital lesions. Few studies have investigated the combination transnasal-sublabial approach to the orbit [6,7]. Alimomahadi et al described their treatment experience with the combined endonasal and sublabial transantral approach for 4 patients with orbital and pterygopalatine fossa pathologies [6].…”

“…Har-El et al described this combined approach for 2 patients with orbital apex lesions. They highlighted the advantages of this approach: it provided excellent visualization and avoided the struggle between surgical instruments and the endoscope, which is often encountered with the transnasal approach alone [7].…”

“…The present study aimed to evaluate the combined transnasal and transantral approach for orbital tumors and to assess the different advantages of a pure mononostril approach and the combined approach. Only a few studies have described the combined transnasal and sublabial transantral approach [6,7].…”

Endoscopic Endonasal Intraconal Approach for Orbital Tumor Resection: Case Series and Systematic Review

“…However, removal of the periorbita or additional fat dissection may result in orbital fat herniation that can lead to permanent or transient diplopia, enophthalmos, and strabismus ( 8 ). Some surgeons suggested reconstruction of the medial orbital wall with bone and nasoseptal flap in case of large defect ( 16 , 17 ). It was reported to use a thick silastic sheet in the nasal cavity to prevent orbital content herniation then remove 4 weeks after the surgery ( 18 ).…”