Purpose: The purpose of this article and accompanying video is to demonstrate a transorbital endoscopic approach for accessing the pterygopalatine fossa (PPF). This technique does not require a skin incision, avoids dissection of critical neurovascular structures, and utilizes a comparatively small osteotomy. The 2 cases presented in this article highlight the utility of a transorbital endoscopic approach for accessing an anatomic region that has traditionally required more invasive techniques to reach.
Methods: Description of surgical technique with 2 illustrative clinical cases and accompanying surgical video.
Results: Surgical technique: A trans-conjunctival approach is taken to the inferior orbital rim, and a subperiosteal dissection is propagated posteriorly. The bone of the posterior orbital floor is then deroofed, and the superior portion of the posterior wall of the maxillary sinus is removed, allowing access to the PPF for an incisional biopsy.
Case: A 76-year-old male with a history of left cheek squamous cell carcinoma presented with progressive V2 paresthesia and an abnormally enhancing lesion in the left PPF on MRI.
Case: A 58-year-old male with no significant medical history presented with left facial numbness (V1-V3), ptosis, an abduction deficit, and decreased hearing. Contrast-enhanced MRI demonstrated an abnormally enhanced lesion in the left PPF extending to Meckel's cave.The transorbital approach described was used to successfully obtain a diagnostic biopsy in both cases.
Conclusions: These cases highlight the utility of a transorbital endoscopic approach to the PPF as a less morbid alternative to traditional access. Patient selection is key to identifying appropriate cases.
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http://dx.doi.org/10.1097/IOP.0000000000002546 | DOI Listing |
J Clin Med
November 2024
Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA 94303, USA.
: This study aims to compare the surgical outcomes of transorbital versus endonasal endoscopic approaches for orbital subperiosteal abscess drainage. : A retrospective review was conducted at a single institution of patients who underwent orbital subperiosteal abscess drainage from November 2009 to April 2023. : Of 64 patients, 44 (68.
View Article and Find Full Text PDFActa Neurochir (Wien)
December 2024
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
Background: Endoscopic transorbital approach (eTOA) has been recently proposed as an alternative skull base approach. However, its feasibility for deeper lesions can be hampered by a reduced surgical maneuverability. Aim of this study is to consider how its extension through orbital rim resection can overcome this limitation, and to compare two different techniques for its removal.
View Article and Find Full Text PDFJ Clin Neurosci
January 2025
Neurosurgery, National Institute of Mental Health and Neuroscience, Bengaluru, Karnataka, India.
J Craniofac Surg
November 2024
Department of Neurosurgery, School of Medicine, Dokuz Eylul University.
Cancers (Basel)
November 2024
Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples "Federico II", 80131 Naples, Italy.
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