The Orbital Floor is a Surgical Landmark for the Asian Anterior Skull Base

Wuttiwongsanon, Chairat; Chaowanapanja, Pattraporn; Harvey, Richard J.; Sacks, Raymond; Schlosser, Rodney J.; Chusakul, Supinda; Aeumjaturapat, Songklot; Snidvongs, Kornkiat

doi:10.2500/ajra.2015.29.4232

Cited by 11 publications

(21 citation statements)

References 12 publications

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“…Intraoperatively, surgeons need a classification that is more practical for them to use. From studies conducted [4][5][6]13 , there was an average of at least 10 mm vertical distance from OF to the critical anatomy, namely; Table 3. The distribution of TMS (Thailand-Malaysia-Singapore) and Keros classifications 7 .…”

Section: Discussionmentioning

confidence: 99%

“…The frequency of these variations may differ among different populations, but the orbital floor (OF) is always in constant position relative to the skull base that slopes posteriorly [2][3][4][5] . The OF or the medial maxillary sinus roof is known as an important intraoperative reference point to ensure a safe dissection and entry to the posterior sinuses (posterior ethmoid and sphenoid sinuses) [3][4][5][6] . It is a useful landmark when the normal anatomical structures are distorted by tumour or previous surgery.…”

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confidence: 99%

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A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery

Abdullah

Chew

Aziz

et al. 2020

Sci Rep

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Keros and Gera classifications are widely used to assess the risk of skull base injury during endoscopic sinus surgery. Although, both classifications are useful preoperatively to stratify risk of patients going for surgery, it is not practical to measure the respective lengths during surgery. In this study, we aimed to propose a new radiological classification (Thailand-Malaysia-Singapore (TMS)) to assess the anatomical risk of anterior skull base injury using the orbital floor (OF) as a reference. A total of 150 computed tomography images of paranasal sinuses (300 sides) were reviewed. The TMS classification was categorized into 3 types by measuring OF to cribriform plate and OF to ethmoid roof. Most patients were classified as TMS type 1, Keros type 2 and Gera class II, followed by patients classified as TMS type 3, Keros type 1 and Gera class 1. TMS has significant correlation with Keros classification (p < 0.05). There was no significant correlation between Keros and Gera classifications (p = 0.33) and between TMS and Gera classifications (p = 0.80). The TMS classification has potential to be used for risk assessment of skull base injury among patients undergoing ESS. It serves as an additional assessment besides the Keros and Gera classifications.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery

Abdullah

Chew

Aziz

et al. 2020

Sci Rep

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“…For cases in which the ostium cannot be identified, the use of a reliable landmark is essential. Orbital walls are fixed anatomical landmarks used when the sphenoid sinus ostium is not clearly seen 16. The level of orbital floor is always below the sphenoid roof, and this indicates the level of sphenoid ostium 16.…”

Section: Surgical Managementmentioning

confidence: 99%

“…Orbital walls are fixed anatomical landmarks used when the sphenoid sinus ostium is not clearly seen 16. The level of orbital floor is always below the sphenoid roof, and this indicates the level of sphenoid ostium 16. The medial orbital wall indicates the lateral wall of the sphenoid sinus including the location of the optic nerve and the internal carotid artery.…”

Section: Surgical Managementmentioning

confidence: 99%

Chronic sphenoid rhinosinusitis: management challenge

Charakorn¹,

Snidvongs²

2016

JAA

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Chronic sphenoid rhinosinusitis is a spectrum of inflammatory diseases in isolated sphenoid sinus which may persist over a period of 12 weeks. It is a different entity from other types of rhinosinusitis because clinical presentations include headache, visual loss or diplopia, and patients may or may not have nasal obstruction or nasal discharge. Nasal endoscopic examination is useful, and computed tomography is mandatory. The disease requires comprehensive knowledge and appropriate imaging technique for diagnosis. To treat patients with chronic sphenoid rhinosinusitis, surgical treatment with endoscopic transnasal sphenoidotomy is often required. As there are no recent updated reviews of chronic sphenoid rhinosinusitis, in this article, we review the anatomy of the sphenoid sinus and its clinical relationship with the clinical signs and symptoms of the disease, the imaging findings of each diagnosis and the comprehensive surgical techniques.

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“…The OF is considered as an important intraoperative reference point as a guide during endoscopic sinonasal surgery [ 12 , 14 ]. The OF comprises mostly of the orbital plate of the maxilla and the tiny orbital plate of the palatine bone posteriorly and by the inferior orbital process of the zygoma anterolaterally.…”

Section: Introductionmentioning

confidence: 99%

Is orbital floor a reliable and useful surgical landmark in endoscopic endonasal surgery?: a systematic review

Abdullah

Chuen

Husain

et al. 2018

BMC Ear Nose Throat Disord

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BackgroundThe orbital floor is considered as an important intraoperative reference point in endoscopic sinonasal surgery. The aim of this review is to evaluate its reliability and usefulness as a surgical landmark in endoscopic endonasal surgery.MethodsA literature search was performed on electronic databases, namely PUBMED. The following keywords were used either individually or in combination: orbital floor; maxillary sinus roof; endoscopic skull base surgery; endoscopic sinus surgery. Studies that used orbital floor as a landmark for endoscopic endonasal surgery were included in the analysis. In addition, relevant articles were identified from the references of articles that had been retrieved. The search was conducted over a period of 6 months between 1st June 2017 and 16th December 2017.ResultsOne thousand seven hundred forty-three articles were retrieved from the electronic databases. Only 5 articles that met the review criteria were selected. Five studies of the orbital floor (or the maxillary sinus roof) were reviewed, one was a cadaveric study while another 4 were computed tomographic study of the paranasal sinuses. All studies were of level III evidence and consists of a total number of 948 nostrils. All studies showed the orbital floor was below the anterior skull base irrespective of the populations. The orbital floor serves as a guide for safe entry into posterior ethmoids and sphenoid sinus.ConclusionsThe orbital floor is a reliable and useful surgical landmark in endoscopic endonasal surgery. In revision cases or advanced disease, the normal landmarks can be distorted or absent and the orbital floor serves as a reference point for surgeons to avoid any unintentional injury to the skull base, the internal carotid artery and other critical structures.

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The Orbital Floor is a Surgical Landmark for the Asian Anterior Skull Base

Abstract: Although a statistical difference exists between racial groups, clinically, the orbital floor is a useful fixed anatomic landmark for ESBS for both Asian and white populations.

Cited by 11 publications

References 12 publications

A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery

A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery

Chronic sphenoid rhinosinusitis: management challenge

Is orbital floor a reliable and useful surgical landmark in endoscopic endonasal surgery?: a systematic review

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