Mueller Sarina K, Freitag Suzanne K, Bleier Benjamin S
Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Otolaryngology, University of Erlangen-Nuremberg, Erlangen, Germany.
Ophthalmic Plast Reconstr Surg. 2018 May/Jun;34(3):254-257. doi: 10.1097/IOP.0000000000000940.
Endoscopic approaches to the orbit improve the ability to directly access apical lesions while minimizing manipulation of normal structures. Inferomedial orbital access is limited by the orbital process of the palatine bone (OPPB) which prevents dissection and retraction in the inferolateral vector.
The objective of this study was to examine the morphometric characteristics of the OPPB and quantify the benefit of complete resection to surgical access.
Morphometric osteologic measurements of the OPPB were performed in 59 human skulls. A radius subtended by the OPPB was calculated to generate a hemispheric dissection corridor achievable by complete resection of the OPPB. Cadaveric and live surgical dissections were then performed on 15 orbits to develop discreet endoscopic surgical landmarks which could be used to both identify the OPPB and verify complete resection.
The mean(± SD) radius of the OPPB was 0.47 ± 0.28 cm. Complete OPPB resection provided an additional 0.36 ± 0.42 cm of surgical exposure within the inferomedial apex. Relative to the Caucasian (n = 27) skulls, the radii in the Asian (n = 27) and African (n = 5) skulls were significantly smaller (p < 0.001 and p = 0.02, respectively).
The OPPB significantly limits surgical access to the inferomedial orbital apex during endoscopic approaches. Complete surgical resection of the OPPB improves surgical exposure facilitating retraction of the inferior rectus muscle and circumferential dissection of lesions within this space. Knowledge of the morphology and clinical relevance of this structure provides an opportunity to improve surgical exposure for relevant pathologic assessment and optimize endoscopic surgical outcomes.
内镜入路眼眶可提高直接到达眶尖病变的能力，同时尽量减少对正常结构的操作。眶下内侧入路受腭骨眶突（OPPB）限制，该结构阻碍了向眶外下方向的分离和牵拉。
本研究旨在研究OPPB的形态学特征，并量化完全切除对手术入路的益处。
对59个人类颅骨进行OPPB的形态学骨测量。计算由OPPB所对的半径，以生成通过完全切除OPPB可实现的半球形分离通道。然后在15个眼眶上进行尸体解剖和活体手术解剖，以确定可用于识别OPPB和验证完全切除的内镜手术标志。
OPPB的平均（±标准差）半径为0.47±0.28cm。完全切除OPPB可在内下眶尖提供额外0.36±0.42cm的手术暴露。相对于高加索人（n = 27）颅骨，亚洲人（n = 27）和非洲人（n = 5）颅骨的半径明显较小（分别为p < 0.001和p = 0.02）。
在内镜入路过程中，OPPB显著限制了进入眶下内侧眶尖的手术入路。完全手术切除OPPB可改善手术暴露，便于下直肌牵拉以及该区域内病变的环形分离。了解该结构的形态学和临床相关性为改善相关病理评估的手术暴露和优化内镜手术结果提供了机会。
