Endoscopic endonasal intraconal orbit surgery

Abstract

Endoscopic endonasal orbital surgery is evolving. With increasing knowledge, expertise, and technology, the historical limits of the endonasal endoscopic approach to the orbit have been redefined. This review discusses the clinical presentation and etiology, and highlights the pertinent anatomy, and discusses the diagnostic workup and surgical approach to orbital tumors and post‐operative care. The role of the multidisciplinary team is not to be underestimated. The introduction of a classification system to ensure standardization of technical difficulty and outcome data will assist with international collaboration and further consolidate our attainment of knowledge in this developing field.

Orbital hemangioma extirpation via a transnasal endoscopic surgical approach: A case report

“…Therefore, three- or four-hand dissection would be used through a single naris for stage II and stage III. As indicated, the panelists advise using a binarial approach for later-stage tumors, likely because it provides better lateral access through the contralateral naris without the need for angled instrumentation and more workspace for three- or four-hand dissection [5] , [9] , [18] . We chose a uninarial approach because the tumor lesions were extraconal.…”

“…Preserving orbital volume is the primary reason for considering medial orbital wall reconstruction—especially when resectioning large intraconal or extraconal lesions—placing orbital fat over exposed muscles outside the eye to prevent scarring. A surgeon should avoid orbital fat because it can cause orbital volume decrease, enophthalmos, and diplopia [9] .…”

“…Currently, the posterior orbital masses located medial and inferior to the optic nerve can be safely accessed endoscopically. This approach can still be developed for use with lesions located lateral to the optic nerve [5] , [8] , [9] . Here, we report a hemangioma case successfully treated with functional endoscopic sinus surgery (FESS) using a uninarial approach according to the surgical case report guidelines [10] .…”

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 ).…”

A novel landmark for endonasal surgery of the pterygopalatine fossa and inferior orbital fissure: The orbito‐pterygo‐sphenoidal ligament

“…In addition, endonasal approaches to tackle lesions in the extraconal or intraconal space have gained popularity during the past three decades. 16 The gap between the medial and inferior recti muscles may be used as part of a minimally invasive endonasal corridor for intraconal tumor extirpation. 17 Given the intimate relationship between the orbit and the neurovascular bundles in the PPF, inadvertent injury to structures in PPF may be encountered during an endonasal approach to the orbit.…”