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

Abstract

Background: We investigated the indications for a combined endoscopic transnasal and sublabial transantral approach for the surgical treatment of orbital lesions. Methods: This case study enrolled 10 patients scheduled for endoscopic transnasal surgery for treating orbital lesions from 2009 to 2020. When the tumor was localized to the medial part of the orbit, patients underwent endoscopy with a transnasal mononostril approach. Alternatively, when the tumor was localized to the mediocaudal part of the orbit, and when instrument maneuverability was limited, the transnasal approach was combined with a sublabial transantral approach. This two-port surgery approach was preferred over a trans-septal approach (binostril approach), because the two-port approach could expand the operating field in the medial part of the orbit. Here, we evaluated the indications, complications, and advantages of monoportal and combined two-portal approaches. Results: Among the 10 patients enrolled, 8 (80.0%) underwent surgery with the transnasal mononostril approach, and 2 (20.0%) underwent surgery with the combined transnasal mononostril and sublabial transantral approach. In the two latter cases, visualization of the operation field was excellent, and there was adequate room for manipulating instruments. No dysesthesia in the region of infraorbital nerve was observed postoperatively.Conclusion: The combination mononostril-transantral approach provided the space necessary to maneuver instruments and to visualize the surgical field in treating mediocaudal orbital lesions. This two-portal approach enabled extensive resections of intraconal lesions; thus, it could be considered a suitable alternative to the binostril approach.