Endoscopic Transnasal Orbital Decompression

Abstract

Orbital decompression for dysthyroid orbitopathy has traditionally been performed through either an external or a transantral approach. The advent of intranasal endoscopes allowed for the development of a transnasal approach for medial and inferior orbital wall decompression. Using this approach, orbital decompressions were performed on 13 orbits in eight patients with severe complicated dysthyroid orbitopathy. Simultaneous bilateral lateral orbitotomies were performed on five patients. Walsh-Ogura decompressions and lateral orbitotomies were performed on two orbits. When combined with lateral orbitotomy, Hertel measurements improved an average of 5.7 mm in orbits decompressed transnasally and 4.5 mm in orbits decompressed with a Walsh-Ogura approach. Transnasal decompression alone improved Hertel measurements an average of 4.7 mm. Visual acuity improved in three of four patients with optic neuropathy, and in all patients with exposure keratopathy. We conclude that the endoscopic transnasal approach provides comparable decompression to traditional methods while avoiding the morbidity of an external ethmoidectomy or Caldwell-Luc antrotomy.

The application of stereotactic navigation surgery to orbital decompression for thyroid-associated orbitopathy

“…7 In the demand for small incision surgery in modern day surgical era, recent trends have been towards both anaesthetically insignificant incisions and endoscopic approaches, although concurrently reducing the incidence of postoperative diplopia and iatrogenic injury. [6][7][8][9][10][11][12][13][14][15] With the advent of smaller incision orbital surgery, perspective and localization becomes increasingly difficult and may pose a limitation against maximal decompression. However, even when good exposure of the floor is obtained through the transorbital approach reported by McCord 21 and Anderson and Linberg, 22 the medial wall view can occasionally be difficult, particularly with bleeding in the crucial area of the orbital apex, with potentially unpleasant consequences for both clinicians and patients.…”

“…[1][2][3][4][5][6] The mainstay of treatment has been two wall decompression originally described by Walsh and Ogura 4 in 1957, modified into an endoscopic formulation by Kennedy in 1990. 7 Although inferomedial orbital decompression has afforded good results in terms of proptosis reduction, it accrues a large risk of postoperative diplopia, with rates of postoperative motility imbalance as high as 80%. 8 In fact, even with the creation of a strut at the ethmoid-maxillary junction, two wall decompression still carries such a high risk of postoperative diplopia 9,10 that some surgeons do not even consider it to be a complication.…”

Endoscopic orbital decompression for thyroid eye disease

“…Endoscopic dacryocystorhinostomy and orbital decompressions have been shown to be both effective and associated with a low morbidity. [6][7][8] Endoscopic orbital surgery allows clear visualisation of orbital structures with no need for a skin incision.…”

Endoscopic orbital decompression for Graves’ ophthalmopathy

“…6 Following the advent of the Hopkins' rod and the technique of nasal endoscopy, visualization of the nasal cavity and paranasal sinuses has improved signi cantly. 7 This has led to the adoption of endoscopic sinus surgery for the treatment of nasal conditions by the majority of otolaryngologists. As the surgeons' endoscopic experience has improved, the spectrum of minimally invasive trans-nasal procedures has extended to include dacryocystorhinostomy, CSF leak repairs, hypophysectomy and major arterial ligation.…”

“…15 Endoscopic orbital decompression was rst reported in 1990 with axial proptosis being reduced by a mean of 5.7.mm when combined with lateral orbitotomy and 4.7.mm when decompressed by an endoscopic approach alone. 7 As other surgeons have developed the technique, reported mean reductions in proptosis now range from 3.0 to 4.7.mm 1,5,7,[16][17][18][19][20][21] (Table I). These gures are similar to the endoscopic decompression achieved in this series with a mean retrogression of 4.4.mm.…”