Anatomy of endoscopic endonasal intraorbital surgery

LIU Jian-Feng; ZHAO Jian-Hui; ZHAO Yu; WANG Yi-Bei; CHEN Zhong-Yan; HAN Jun; YANG Da-Zhang

doi:10.16098/j.issn.0529-1356.2020.05.014

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Acta Anatomica Sinica ›› 2020, Vol. 51 ›› Issue (5) : 719-725. DOI: 10.16098/j.issn.0529-1356.2020.05.014

Anatomy of endoscopic endonasal intraorbital surgery

LIU Jian-feng ZHAO Jian-hui* ZHAO Yu WANG Yi-bei CHEN Zhong-yan HAN Jun* YANG Da-zhang

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Abstract

Objective To identify the anatomic landmarks of endoscopic endonasal intraorbital approach, and to present two illustrative cases. Methods Three silicon-injected adult cadaveric heads (6 sides) were dissected, using the endosopic surgical instruments to perform the endoscopic endonasal intraorbital approach and the Karl Storz Image1 system to record the entire process. Results Important landmarks, such as the medial orbital wall, part of the inferior orbital floor, periorbita in the deep layer, and intraorbital fat in the superficial layer could be identified using this approach. Furthermore, medial rectus muscle, superior oblique muscle and inferior rectus muscle could also be recognized. Following dissecting the space between the medial rectus muscle and the inferior rectus muscle, the intraconal space could be accessed. After removing the intraconal fat, important vessels and nerves were identified, including the ophthalmic artery and its inferior medial muscular trunk, the optic nerve, and the branches of oculomotor nerve. One case was metallic intraorbital intraconal foreign body and the other one was cavernous hemangioma in the orbital apex involving the pterygopalatine fossa and infratemporal fossa. These two surgeries were both successfully performed, and the aims of the operation were all achieved. Both patients recovered well, and no postoperative complications ccurred. Conclusion An understanding of the landmarks of the intraorbital structures is paramount for surgically dealing with diseases located within or adjacent to this region. The endoscopic endonasal intraorbital approach is safe, effective and minimally invasive for appropriately selected cases.

Key words

Intraorbital structure / Transnasal / Rhino-orbital surgery / Foreign body / Cavernous hemangioma / Endoscopy / Anatomy / Human

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LIU Jian-feng ZHAO Jian-hui ZHAO Yu WANG Yi-bei CHEN Zhong-yan HAN Jun YANG Da-zhang. Anatomy of endoscopic endonasal intraorbital surgery[J]. Acta Anatomica Sinica. 2020, 51(5): 719-725 https://doi.org/10.16098/j.issn.0529-1356.2020.05.014

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