Kim Jonathan W, Yates Barbara S, Goldberg Robert A
Division of Oculofacial and Orbital Surgery, Department of Ophthalmology, Stanford Medical Center, Palo Alto, California, USA.
Orbit. 2009;28(6):320-7. doi: 10.3109/01676830903334028.
The goal of this study was to evaluate the safety and efficacy of performing a total lateral orbitotomy (TLO) to enhance the surgical exposure of the deep orbit.
Ten orbits of five fresh-frozen cadaver heads were dissected to evaluate TLO surgical techniques. Through an eyelid approach, a bone flap extending from the supraorbital nerve to the infraorbital nerve was removed to enhance exposure to the orbital apex. The surgical exposure was further augmented by removing bone with the high-speed burr from the greater wing of sphenoid bone along the deep lateral wall. Anatomic landmarks that identified various compartments within the lateral wall and orbital roof were noted and measured. Five patients with posterior orbital tumors underwent TLO utilizing extended bone flaps and their surgical results and clinical outcomes were recorded.
The findings from this study demonstrate that the entire orbital rim from the supraorbital nerve to the infraorbital nerve may be removed without damaging critical neurovascular structures or creating a dural defect. Strategic removal of bone from the deep lateral wall can further enhance the exposure to the orbital apex. Five patients with deep orbital lesions underwent TLO with excellent surgical outcomes.
By utilizing TLO techniques in a patient with a deep orbital lesion, the modern orbital surgeon can access the orbital apex safely and predictably through an eyelid approach.
本研究的目的是评估进行全外侧眶切开术（TLO）以增强深部眼眶手术暴露的安全性和有效性。
对5个新鲜冷冻尸体头部的10个眼眶进行解剖，以评估TLO手术技术。通过眼睑入路，切除一块从眶上神经延伸至眶下神经的骨瓣，以增强对眶尖的暴露。沿着外侧深部壁用高速磨钻去除蝶骨大翼的骨，进一步扩大手术暴露。记录识别外侧壁和眶顶内各个腔隙的解剖标志并进行测量。5例眼眶后部肿瘤患者接受了使用延长骨瓣的TLO手术，并记录了他们的手术结果和临床结局。
本研究结果表明，从眶上神经到眶下神经的整个眶缘可以切除，而不会损伤关键的神经血管结构或造成硬脑膜缺损。从外侧深部壁有策略地去除骨可以进一步增强对眶尖的暴露。5例深部眼眶病变患者接受了TLO手术，手术效果良好。
通过在深部眼眶病变患者中使用TLO技术，现代眼眶外科医生可以通过眼睑入路安全且可预测地到达眶尖。
