Kenyon Bianca, Antisdel Jastin L
Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, Saint Louis, Missouri, USA.
Am J Rhinol Allergy. 2014 Jan-Feb;28(1):82-5. doi: 10.2500/ajra.2014.28.4000.
This anatomic study investigates the feasibility of an endoscopic transnasal transorbital approach to the lateral orbital apex.
Five cadavers with no prior history of sinus surgery were studied bilaterally. Standard techniques and instrumentation for functional endoscopic sinus surgery were used to perform dissections and delineate anatomy of sinuses and orbits.
With resection of the inferior aspect of the lamina papyracea and the medial portion of the orbital floor, followed by incision of the periorbita along the inferomedial aspect of the orbit and removal of minimal orbital fat, a satisfactory view of the surgical field is achieved. The medial and inferior rectus muscles are dissected and retracted to allow visualization of the optic nerve. By dissecting inferior to the optic nerve and using 0 and 30° endoscopes, the lateral orbital apex could be accessed without damage to the optic nerve.
In patients whose vision is irreparably damaged, one might consider an endoscopic approach to lesions of the lateral orbital apex. Approach in patients with intact vision should be handled with caution because of possible traction of the optic nerve.
本解剖学研究探讨经鼻内镜经眶入路至眶外侧尖的可行性。
对5具无鼻窦手术史的尸体双侧进行研究。采用功能性内镜鼻窦手术的标准技术和器械进行解剖，并描绘鼻窦和眼眶的解剖结构。
切除纸样板的下方部分和眶底的内侧部分，然后沿眼眶的内下侧切开眶周组织并去除少量眶脂肪，可获得满意的手术视野。解剖并牵开内直肌和下直肌，以显露视神经。通过在视神经下方进行解剖并使用0°和30°内镜，可在不损伤视神经的情况下进入眶外侧尖。
对于视力已遭受不可修复损害的患者，可考虑采用内镜入路治疗眶外侧尖病变。对于视力正常的患者，由于可能对视神经造成牵拉，应谨慎处理入路。
