A Modified Lateral Orbitotomy Approach to the Superior Orbital Fissure: A Video Case Report and Review of Anatomy

2018 ◽  
Vol 16 (6) ◽  
pp. 685-691 ◽  
Author(s):  
Gmaan A Alzhrani ◽  
Yair M Gozal ◽  
Brandon A Sherrod ◽  
William T Couldwell
Keyword(s):  
Patient Experiences ◽  
Total Resection ◽  
Superior Orbital Fissure ◽  
Good Cosmetic Outcome ◽  
Lateral Orbitotomy ◽  
Orbital Wall ◽  
Good Cosmetic ◽  
Histopathologic Analysis ◽  
Video Case Report ◽  
Orbital Rim

Abstract BACKGROUND The lateral orbitotomy approach (LOA) is often used for accessing the orbital contents and middle skull base; however, most prior descriptions of the LOA involve complete drilling of the lateral orbital wall. This practice requires retraction of the orbital contents and produces postoperative diplopia that the patient experiences for a limited time. OBJECTIVE To describe a modified LOA with partial sparing of the lateral orbital wall for accessing lesions of the superior orbital fissure (SOF). METHODS One patient with a progressively enlarging SOF lesion and visual loss underwent a modified LOA for resection. The orbital rim lateral to the SOF was removed as a bone flap, and the greater wing of the sphenoid inferior to the SOF was drilled to expose the lesion. The lateral orbital wall was thinned but was not completely removed. The orbital rim was resecured with miniplates and screws. RESULTS Gross total resection of the SOF mass was achieved without unnecessary exposure or retraction of the orbital contents. Histopathologic analysis of the resected mass was consistent with a cavernous hemangioma. The patient had a good cosmetic outcome without complication. CONCLUSION Modified LOA with partial sparing of the lateral orbital wall is a feasible approach for lesions of the SOF.

Three-Piece Orbitozygomatic Approach

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-E119-ons-E120 ◽  
Author(s):  
Alvaro Campero ◽  
Carolina Martins ◽  
Mariano Socolovsky ◽  
Rafael Torino ◽  
Alexandre Yasuda ◽  
...  
Keyword(s):  
Lateral Wall ◽  
Good Cosmetic Result ◽  
Superior Orbital Fissure ◽  
Middle Fossa Approach ◽  
Orbitozygomatic Approach ◽  
Brain Exposure ◽  
Good Cosmetic ◽  
Technical Details ◽  
Technical Features ◽  
Orbital Rim

Abstract Objective: To describe the technical details of a 3-piece orbitozygomatic approach. Introduction: In a 3-piece orbitozygomatic approach, soft tissue exposure is mostly comparable to the classic frontopterional approach. Osseous resection is a 3-piece operation that consists of first performing anterior and posterior cuts along the zygomatic arch, reflecting it down, attached to the masseter. This is followed by a classic frontotem-porosphenoidal craniotomy, and finally, an osteotomy of the orbital rim, roof, and lateral wall of the orbit. Results: When compared with its 1- and 2-piece counterparts, 3-piece orbitozygomatic craniotomy, as described here, is a relatively simple operation and is thus advisable when considering an anterior or middle fossa approach. Brain exposure is wide, whereas cerebral retraction is minimal. We recommend avoiding orbit sectioning as deep as the superior orbital fissure. Conclusion: The modifications described herein show the technical features of the 3-piece orbitozygomatic approach, which provides excellent brain exposure with less retraction and a good cosmetic result.

Sphenoorbital meningioma: surgical technique and outcome

2011 ◽  
Vol 114 (5) ◽  
pp. 1241-1249 ◽  
Author(s):  
Soichi Oya ◽  
Burak Sade ◽  
Joung H. Lee
Keyword(s):  
Surgical Technique ◽  
Visual Outcome ◽  
Sphenoid Bone ◽  
Wide Resection ◽  
Tumor Control ◽  
Subtotal Resection ◽  
Total Resection ◽  
Anterior Clinoid Process ◽  
Orbital Wall

Object The aim of this study was to describe the surgical technique used for removal of sphenoorbital meningiomas in the authors' practice and to review the operative outcome. Methods Review of the senior author's practice between 1994 and 2009 revealed 39 patients (mean age 48 years) eligible for this study. Clinical presentation, surgical technique, postoperative outcome, and follow-up data are presented. Surgical technique is detailed, with an emphasis on aggressive removal consisting of drilling of the hypertrophied sphenoid bone, orbital wall, and anterior clinoid process, followed by tumor removal and a wide resection of the involved dura. A simple dural closure without reconstruction of the orbital roof or the lateral wall of the orbit is also described. Results Gross-total resection was achieved in 15 cases (38.5%), near-total resection with small residual in the cavernous sinus or periorbita in 20 cases (51.3%), and subtotal resection in 4 cases (10.3%). Postoperative complications included trigeminal hypesthesia in 9 patients, oculomotor palsy in 3 patients, and seizure in 2 patients. Seven patients had recurrence within the mean follow-up period of 40.7 months. Preoperative visual deficits were present in 21 patients (53.8%). Of these, 14 (66.7%) experienced visual recovery to normal levels postoperatively. Statistical analyses revealed preoperative severe visual deficit and sphenoid bone hypertrophy as an independent risk factor and an independent favorable factor, respectively, for a favorable visual outcome. Proptosis was resolved (≤ 2 mm) in 73.5% of the authors' patients. No patient had postoperative enophthalmos. Conclusions In the authors' practice, surgery for sphenoorbital meningiomas consists of resection of the orbital/sphenoid intraosseous, intraorbital, and intradural tumor components. The authors believe that aggressive removal of the orbital/sphenoid intraosseous tumor is critical for a favorable visual outcome and tumor control. Furthermore, satisfactory cosmetic results can be achieved with simple reconstruction techniques as described.

scholarly journals Quantitative analysis of the surgical exposure and surgical freedom between transcranial and transorbital endoscopic anterior petrosectomies to the posterior fossa

2019 ◽  
Vol 131 (2) ◽  
pp. 569-577 ◽  
Author(s):  
Raywat Noiphithak ◽  
Juan C. Yanez-Siller ◽  
Juan Manuel Revuelta Barbero ◽  
Bradley A. Otto ◽  
Ricardo L. Carrau ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Additional Benefit ◽  
Range Of Movement ◽  
Statistical Comparison ◽  
Anterior Transpetrosal Approach ◽  
Surgical Exposure ◽  
Orbital Wall ◽  
Anterior Petrosectomy ◽  
Surgical Corridor ◽  
Orbital Rim

OBJECTThis study proposes a variation of the transorbital endoscopic approach (TOEA) that uses the lateral orbit as the primary surgical corridor, in a minimally invasive fashion, for the posterior fossa (PF) access. The versatility of this technique was quantitatively analyzed in comparison with the anterior transpetrosal approach (ATPA), which is commonly used for managing lesions in the PF.METHODSAnatomical dissections were carried out in 5 latex-injected human cadaveric heads (10 sides). During dissection, the PF was first accessed by TOEAs through the anterior petrosectomy, both with and without lateral orbital rim osteotomies (herein referred as the lateral transorbital approach [LTOA] and the lateral orbital wall approach [LOWA], respectively). ATPAs were performed following the orbital approaches. The stereotactic measurements of the area of exposure, surgical freedom, and angles of attack to 5 anatomical targets were obtained for statistical comparison by the neuronavigator.RESULTSThe LTOA provided the smallest area of exposure (1.51 ± 0.5 cm2, p = 0.07), while areas of exposure were similar between LOWA and ATPA (1.99 ± 0.7 cm2 and 2.01 ± 1.0 cm2, respectively; p = 0.99). ATPA had the largest surgical freedom, whereas that of LTOA was the most restricted. Similarly, for all targets, the vertical and horizontal angles of attack achieved with ATPA were significantly broader than those achieved with LTOA. However, in LOWA, the removal of the lateral orbital rim allowed a broader range of movement in the horizontal plane, thus granting a similar horizontal angle for 3 of the 5 targets in comparison with ATPA.CONCLUSIONSThe TOEAs using the lateral orbital corridor for PF access are feasible techniques that may provide a comparable surgical exposure to the ATPA. Furthermore, the removal of the orbital rim showed an additional benefit in an enhancement of the surgical maneuverability in the PF.

Lateral Orbitotomy Without Removal of the Lateral Orbital Rim

1988 ◽  
Vol 106 (10) ◽  
pp. 1463-1468 ◽  
Author(s):  
J. D. Wirtschafter ◽  
A. E. Chu
Keyword(s):  
Lateral Orbitotomy ◽  
Orbital Rim

Seesaw Modification of the Lateral Orbital Wall in Le Fort III Osteotomy

2004 ◽  
Vol 41 (6) ◽  
pp. 579-583 ◽  
Author(s):  
M. Emin Mavili ◽  
Gökhan Tunçbilek
Keyword(s):  
Long Term Effects ◽  
Traditional Treatment ◽  
Le Fort ◽  
Syndromic Craniosynostosis ◽  
Smooth Contour ◽  
Le Fort Iii ◽  
Orbital Wall ◽  
Conventional Methods ◽  
Orbital Rim

Objective The traditional treatment for patients with syndromic craniosynostosis and midfacial retrusion has consisted of Le Fort III osteotomy and advancement. Distraction with rigid external systems allows advancement of the midface segment much more than the conventional methods. This excessive advancement resulted in the superiormost margin of the advancement segment becoming prominent. It can be felt easily with palpation and may influence the appearance of the patient negatively. This article presents a procedure osteotomy designed to modify the osteotomy lines at the lateral orbital rims and smooth the step deformity at the lateral canthal region. Results The seesaw osteotomy produced a smooth contour at the lateral orbital rim. Planned advancement was achieved without difficulty and without adverse long-term effects.

scholarly journals Initial Experience with Simple Oncoplastic Breast Conserving Surgery in Nepal: A Case Report

2020 ◽  
Vol 42 (2) ◽  
pp. 97-99
Author(s):  
Yogendra P Singh ◽  
Suman Khanal
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Outer Quadrant ◽  
Good Cosmetic Outcome ◽  
Node Biopsy ◽  
Areola Complex ◽  
Good Cosmetic

Oncoplastic breast conserving surgery is increasingly used in the management of early breast cancer. Though its use in Nepal is increasing, it is still under-utilized. We present a case of upper outer quadrant early breast cancer located away from nipple-areola complex managed with radial ellipse segmentectomy 10 years back and under regular follow up. We recommend its usage in upper outer quadrant lesions because of its simplicity, access for sentinel lymph node biopsy and good cosmetic outcome.

scholarly journals New Algorithm for the Management of Orbital Blowout Fracture Based on Prospective Study

2018 ◽  
Vol 11 (4) ◽  
pp. 285-295 ◽  
Author(s):  
Babak Alinasab ◽  
Karl-Johan Borstedt ◽  
Rebecka Rudström ◽  
Michael Ryott ◽  
Abdul Rashid Qureshi ◽  
...  
Keyword(s):  
Prospective Study ◽  
Ct Scan ◽  
Clinical Findings ◽  
Infraorbital Nerve ◽  
Ocular Motility ◽  
Posterior Edge ◽  
Blowout Fracture ◽  
Orbital Wall ◽  
Orbital Rim ◽  
Nonoperated Group

Despite extensive debate and publications in the management of blowout fracture (BOF), there are still considerable differences in the surgeons’ management of BOF due to a lack of reliable evidence-based studies. This article aimed to evaluate which BOF patients require surgical treatment due to functional and/or cosmetic deformities; evaluate which computed tomography (CT) scan findings predict these problems; and provide an algorithm in the management of BOF. Seventy-nine patients with BOF were treated conservatively and followed up prospectively regarding functional and cosmetic deformities for at least 1 year. The patients’ CT scans were analyzed and several measurements were performed. Patients’ symptoms and the clinical findings were correlated to the CT scan measurements. We found visible deformity in 37% of the patients, but only 10% chose to proceed to surgery due to cosmetic deformities. In patients with inferior BOF and a herniation < 1.0 mL, a visible deformity was found when the ratio between fracture and the fractured orbital wall areas was ≥42%, or the total area of the fracture was ≥ 2.3 cm2. In patients with inferior BOF and a herniation ≥ 1.0 mL, a visible deformity was found when the distance from the inferior orbital rim to the posterior edge of the fracture was ≥ 3.0 cm. In patients with inferomedial fracture, a visible deformity was found when the herniation was ≥ 0.9 mL. Diplopia improved significantly and remained in only 3% of the patients in nonoperated group. Hypoesthesia of the infraorbital nerve improved significantly, but 23% of the nonoperated and 50% of the operated patients still experienced loss of sensation at final control. In this prospective study, we found that not only herniated orbital volume but also other CT scan findings in BOF were crucial to predict late visible deformities. Based on these findings, we propose an algorithm for the prediction of late visible deformity with 83% accuracy. There are indications that diplopia without ocular motility disorder is due to edema and we recommend observation as long as the diplopia improves gradually.

Zygomaticomaxillary Complex Fractures

2019 ◽  
pp. 623-632
Author(s):  
Russell E. Ettinger ◽  
Steven R. Buchman
Keyword(s):  
Soft Tissue ◽  
Close Association ◽  
Fracture Repair ◽  
Rigid Fixation ◽  
Concomitant Injuries ◽  
Orbital Wall ◽  
The Face ◽  
Bone Fragments ◽  
Orbital Rim ◽  
Zygomaticomaxillary Complex

The zygomatic bone is a critical component of the midfacial complex. Its prominence within the face makes it susceptible to trauma and its intricate anatomy make posttraumatic repair of zygomaticomaxillary complex (ZMC) fractures challenging. The zygoma has a “tetrapod” structure with four key articulation points: the zygomaticomaxillary articulation and inferior orbital rim, zygomaticosphenoid articulation in the lateral orbital wall, zygomaticofrontal articulation and the lateral orbital rim, and the zygomatic arch. The zygoma is also a key contributor to several facial buttresses and a main determinant of malar projection and transverse facial width. Several approaches to the ZMC may be required to ensure appropriate reduction of each articulation site during operative repair. Concomitant injuries to other facial structures can be seen with ZMC fractures, given the zygomatic bones close association with the orbit, nasal bones, and the maxilla. Adequate ZMC fracture repair requires appropriate exposure of all involved fractures, robust mobilization of bone fragments, and application or rigid fixation while ensuring simultaneous reduction at all involved ZMC articulation points. Midface soft tissue resuspension should be performed following ZMC reduction and fixation to prevent unwanted soft tissue descent and lower lid malposition.

Posterior Border of the Deep Lateral Orbital Wall—Appearance, Width, and Distance From the Orbital Rim

2008 ◽  
Vol 24 (4) ◽  
pp. 262-265 ◽  
Author(s):  
Hirohiko Kakizaki ◽  
Takashi Nakano ◽  
Ken Asamoto ◽  
Masayoshi Iwaki
Keyword(s):  
Posterior Border ◽  
Orbital Wall ◽  
Orbital Rim
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