Abstract
The authors have identified and described three medial approaches to the intraorbital portion of the optic nerve in cadavers. The structures exposed via the superior, inferior or central approaches were approached through the medial orbital wall. The superior approach in which the medial rectus muscle is retracted inferiorly exposes the superomedial aspect of the orbit. The inferior approach in which the medial rectus muscle is retracted superiorly, provided the inferomedial aspect of the optic nerve from the globe to the muscle cone. The central approach in which the ethmoidectomy was performed and the medial rectus muscle was disinserted and retracted, provided excellent exposure of the structures of the medial part of the orbit and the optic nerve. There were no structures blocking access to the two third anterior optic nerve and medial surface of the globe. The structures encountered in these approaches are demonstrated under magnification in cadavers, and the exposure of the optic nerve is discussed.
Key words
Medial orbit - anatomy - microsurgical approach
References
-
1
Maroon J C, Kenerdell L S.
Surgical approaches to the orbit. Indications and techniques.
J Neurosurg.
1984;
60
1226-1235
-
2
Al-Mefty O, Fox J L.
Superolateral orbital exposure and reconstruction.
Surg Neurol.
1985;
23
609-613
-
3
Hamby W B.
Pterional approach to the orbits for decompression or tumor removal.
J Neurosurg.
1964;
21
15-18
-
4
Housepian E M.
Surgical treatment of unilateral optic nerve gliomas.
J Neurosurg.
1969;
31
604-607
-
5
Jane J A, Park T S, Poberskin L M, Winn H R, Butter A B.
The supraorbital approach; technical note.
Neurosurgery.
1982;
11
537-542
-
6
Maccarty C S, Brown D N.
Orbital tumors in children.
Clin Neurosurg.
1994;
11
76-93
-
7 Brihaye J. Neurosurgical approach to orbital tumors. In: Krayenbühl M (ed). Advances and Technical Standards in Neurosurgery. Wien, New York: Springer Verlag 1976
-
8 Cooper W C, Harris G J. Orbital Surgery. In: Jones IS, Jakobiec FA (eds), Diseases of the Orbit. New York: Harper & Row Publishers Inc 1979
-
9
Kenerdell J S, Maroon J C.
Microsurgical approach to intraorbital tumors. Technique and instrumentation.
Arc Ophthalmol.
1976;
94
1333-1336
-
10
Kim S J, Lew H, Chung S-H, Kook K H, Juan Y, Lee S Y.
Repair of medial orbital wall fracture; transcaruncular approach.
Orbit.
2005;
24
1-9
-
11 Soames R W. Skeletal system. In: Williams PL (ed). Gray's Anatomy, 38th edn. London: ELBS 1995: 425-736
-
12
Natori Y, Rhoton A L.
Transcranial approach to the orbit: Microsurgical anatomy.
J Neurosurg.
1994;
81
78-86
-
13
Anderson D R, Davis E B.
Retina and optic nerve after posterior ciliary artery occlusion.
Arch Ophthalmol.
1974;
92
422-426
-
14
Nolasco F P, Matlog R H.
Medial orbital wall fractures: Classification and clinical profile.
Head and Neck Surg.
1995;
112
549-556
-
15
Forbes G S, Gehring B S, Gorman C A. et al .
Volume measurement of normal orbit by computed tomographic analysis.
Am J Neuroradiol.
1985;
6
419-424
-
16
Charterside D G, Chan C H, Whitehouse R W, Noble J L.
Orbital volume measurement of pure blow-out fractures of the orbital floor.
Br J Ophthalmol.
1993;
77
100-102
-
17
Yab K, Tajima S, Ohba S.
Displacement of eyeball in orbital blowout fractures.
Plast Reconst Surg.
1997;
100
1409-1417
-
18
Leone Jr C R, Lloyd III W C, Rylander G.
Surgical repair of medial wall fractures.
Am J Ophthalmol.
1984;
97
349-356
-
19
Edwards W C, Ridley R W.
Blow-out fracture of medial orbital wall.
Am J Ophthalmol.
1968;
65
248-249
-
20
Rauch S D.
Medial orbital blow-out fracture with entrapment.
Arch Otolaryngol.
1985;
111
53-55
-
21
Converse J M, Hogan V M.
Open-sky approach for reduction of naso-orbital fractures.
Plast Reconstr Surg.
1970;
63
396-398
-
22
Rumelt M B, Ernst J T.
Isolated blow-out fracture of the medial orbital wall with medial rectus muscle entrapment.
Am J Ophthalmol.
1972;
73
451-453
-
23
Domarus H von.
A technique for reconstruction of blow-out fractures of the medial orbital wall-case report.
J Maxillofac Surg.
1974;
2
55-57
-
24
Davidson T M, Olsen R M, Nahum A M.
Medial orbital wall fracture with rectus entrapment.
Arch Otolaryngol.
1975;
101
33-35
-
25
Thering H R, Bogart J N.
Blow-out fracture of the medial wall, with entrapment of the medial rectus muscle.
Plast Reconst Surg.
1979;
63
848-852
-
26
Bartkowski S B, Krzystkowa K M.
Blow-out fracture of the orbit. Diagnostic and therapeutic consideration, and results in 90 patients treated.
J Maxillofac Surg.
1982;
10
155-164
-
27
Magnus W W, Castner D V, Schonder A A. et al .
A conjunctival approach to repair of the medial wall of the orbit.
J Oral Surg.
1971;
29
664-671
-
28
de Visscher G AM, Wal K GH van der.
Medial orbital wall fracture with enophthalmos.
J Craniomaxillofac Surg.
1988;
16
55-59
-
29
Anderson R L, Linberg J V.
Transorbital approach to decompression in Graves’ disease.
Arch Ophthalmol.
1981;
99
120-124
-
30
Naffziger H C.
Exophthalmos. Some surgical principles of surgical management from the neurosurgical aspect.
Ann J Surg.
1948;
75
25-41
-
31
Lynch R C.
The technique of a radical frontal sinus operation which has given me the best results.
Laryngoscope.
1921;
31
1-5
-
32
Leone Jr C R, Piest K L, Newman R J.
Medial and lateral wall decompression for tyroid ophthalmopathy.
Am J Ophthalmol.
1989;
108
160-166
-
33
Esclamado R M, Cummings C W.
Z-plasty modification of the Lynch incision.
Laryngoscope.
1989;
99
986-987
-
34
Osguthorpe J D, Sounders R A, Adkins W Y.
Evaluation of and access to posterior orbital tumors.
Laryngoscope.
1983;
93
766-771
-
35
Lillie H I, Williams H L.
The external fronto-ethmo-sphenoid operation: a critical review of the literature and details of the technique in use at the Mayo Clinic.
Minnesota Med.
1935;
18
786-789
-
36
Neel III H B, McDonald T J, Facer G W.
Modified Lynch procedure for chronic frontal sinus diseases: rational, technique, and long-term results.
Laryngoscope.
1987;
97
1274-1279
-
37
Harrison D F.
Surgical approach to the medial orbital wall.
Ann Otol Rhinol Laryngol.
1981;
90
415-419
-
38
Shorr N S.
“Madame Butterfly” procedure: total lower eyelid reconstruction in 3 layers utilizing a hard palate graft. Management of the unhappy post-blepharoplasty patient with round eye and scleral show.
Int J Aesth Restor Surg.
1995;
3
3-26
-
39
Tenzel R R, Miller G R.
Orbital blow-out fracture repair, conjunctival approach.
Am J Ophthalmol.
1971;
71
1141-1142
-
40
McCord Jr C D, Mosses J L.
Exposure of the inferior orbit with fornix incision and lateral canthotomy.
Ophthalmic Surg.
1979;
10
53-63
-
41
McCord Jr C D.
Orbital decompression for Graves’ disease. Exposure through lateral canthal and inferior fornix incisions.
Ophthalmology.
1981;
88
533-541
-
42
Goldberg R A, Lessner A M, Shorr N, Baylis H I.
The transconjunctival approach to the orbital floor and orbital fat. A prospective study.
Ophthalmic Plast Reconstr Surg.
1990;
6
241-246
-
43
Shorr N, Baylis H I, Goldberg R A, Perry J D.
Transcaruncular approach to the medial orbit and orbital apex.
Ophthalmology.
2000;
107
1459-1463
-
44 McCord Jr C D, Tanenbaum M, Nunery W R. Oculoplastic surgery, 3rd edn. New York: Raven Press 1995: 537-538
-
45
Missori P, Tarantino R, Delfini R, Lunardi P, Cantore G.
Surgical management of orbital cavernous angiomas: prognosis for visual function after removal.
Neurosurgery.
1994;
35
34-37
-
46
Hassler W E, Meyer B, Rohde V, Unsöld R.
Pterional approach to the contralateral orbit.
Neurosurgery.
1994;
34
552-554
-
47
Herman P, Lot G, Portier F. et al .
Transnasal endoscopic removal of an orbital cavernoma.
Ann Otol Rhinol Laryngol.
1999;
108
147-150
-
48
Mun G H, Song Y H, Bang S I.
Endoscopically assisted transorbital approach in orbital medial wall fractures.
Ann Plast Surg.
2002;
49
337-343
-
49
Garcia H G, Goldberg R A, Shorr N.
The transcaruncular approach in repair of orbital fracture: A retrospective study.
J Cranio-maxillofacial Trauma.
1984;
4
7-12
Engin Gönül, M. D.
Department of Neurosurgery · School of Medicine
GATA
06010 Etlik-Ankara
Turkey ·
Phone: +90/312/304/5313
Fax: +90/312/304/5300
Email: engingonul@yahoo.com
