Department of Otolaryngology, University of Colorado, Aurora, Colorado 80045, USA.
Laryngoscope. 2011 Feb;121(2):437-41. doi: 10.1002/lary.21338. Epub 2011 Jan 13.
Access to the medial orbit traditionally has been gained transcutaneously, with potential for associated soft tissue and lacrimal disruption. Endoscopic transnasal approaches to the medial orbit may be limited in certain scenarios by tumor presence or patient-specific factors. The medial transconjunctival approach, or transcaruncular approach, has been recently described for access to the medial orbit in orbital decompression and repair of medial blowout fractures. The aim of this study is to determine the utility of this minimally invasive external approach in the endoscopic management of advanced sino-orbital disease.
This is a cadaver study with additional clinical correlations. The transcaruncular approach was combined with a transnasal endoscopic approach in cadaver dissections performed on eight sides. Five cases are described in which the transcaruncular approach was used as an adjunctive technique in advanced endoscopic sinus surgery.
In cadaver dissection, the transcaruncular approach is a simple, reliable method to ligate the ethmoid arteries and place bony cuts along the medial orbital wall. In certain anatomic configurations, supraorbital dissection into the frontal sinus or anterior fossa may be achieved. In the cases examined, exposure of the medial orbital subperiosteal plane allowed for ligation of ethmoid arteries, assessment of periorbital invasion of disease, assistance in tumor dissection, and placement of a malleable retractor for protection of orbital contents.
The transcaruncular approach to the medial orbit has certain advantages over the traditional open approach. Ligation of the ethmoid arteries, assessment of the lacrimal sac and periorbita for tumor invasion, protection of orbital contents, and en bloc resection of the periorbita and lamina papyrecea are possible through this route.
传统上，经皮入路可进入内侧眶，但存在潜在的软组织和泪器破坏风险。对于某些情况，内镜经鼻入路可能由于肿瘤存在或患者特定因素而受到限制。内侧经结膜入路（或经泪阜入路）最近被描述用于眶减压和内侧爆裂性骨折修复时进入内侧眶。本研究旨在确定这种微创外部入路在内镜治疗晚期鼻窦疾病中的应用价值。
这是一项尸体研究，并结合了额外的临床相关性。在对 8 侧尸体进行的解剖中，联合使用了经泪阜入路和经鼻内镜入路。描述了 5 例病例，其中经泪阜入路作为高级内镜鼻窦手术的辅助技术。
在尸体解剖中，经泪阜入路是一种简单、可靠的方法，可以结扎筛动脉，并在内侧眶壁上进行骨切开。在某些解剖结构中，可向上眶切开进入额窦或前颅窝。在检查的病例中，暴露内侧眶骨膜下平面可结扎筛动脉、评估疾病对眶周的侵犯、协助肿瘤分离以及放置可塑牵开器以保护眶内容物。
与传统的开放入路相比，经泪阜入路进入内侧眶具有一定的优势。通过这条途径可以结扎筛动脉、评估泪囊和眶周组织是否有肿瘤侵犯、保护眶内容物以及整块切除眶周组织和纸样板。
