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Minimally invasive surgery of the anterior skull base: transorbital approaches.

Gassner HG, Schwan F, Schebesch KM - GMS Curr Top Otorhinolaryngol Head Neck Surg (2016)

Bottom Line: The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors.The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature.Their execution requires an interdisciplinary team approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany.

ABSTRACT
Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach.

No MeSH data available.


Related in: MedlinePlus

The precaruncular incision is performed after intubation of the lacrimal canaliculi and retraction with lacrimal duct probes; the caruncula is retracted in medial direction with forceps, the precaruncular incision is performed with a fine monopolar needle.
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Figure 2: The precaruncular incision is performed after intubation of the lacrimal canaliculi and retraction with lacrimal duct probes; the caruncula is retracted in medial direction with forceps, the precaruncular incision is performed with a fine monopolar needle.

Mentions: The precaruncular approach opens the medial quadrant and allows access to the lamina papyracea, the anterior and posterior ethmoid arteries, and the interorbital corridor of the anterior skull base. The technique described by Moe creates an access posterior and lateral to the lacrimal ducts (Figure 2 (Fig. 2)). After inserting a bulb protector, the lacrimal duct probes are inserted in both canaliculi and allow retraction and protection of those structures. The globe is carefully moved in lateral direction by means of a spatula, the caruncula is retracted in lateral direction with small forceps and released with a fine monopolar needle medial along the skin-caruncula border. The incision is extended into the conjunctiva of the upper and lower eyelids and the medial canthal ligament is exposed. The technique described by Raza and Boahene draws the incision in further cranial direction.


Minimally invasive surgery of the anterior skull base: transorbital approaches.

Gassner HG, Schwan F, Schebesch KM - GMS Curr Top Otorhinolaryngol Head Neck Surg (2016)

The precaruncular incision is performed after intubation of the lacrimal canaliculi and retraction with lacrimal duct probes; the caruncula is retracted in medial direction with forceps, the precaruncular incision is performed with a fine monopolar needle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940979&req=5

Figure 2: The precaruncular incision is performed after intubation of the lacrimal canaliculi and retraction with lacrimal duct probes; the caruncula is retracted in medial direction with forceps, the precaruncular incision is performed with a fine monopolar needle.
Mentions: The precaruncular approach opens the medial quadrant and allows access to the lamina papyracea, the anterior and posterior ethmoid arteries, and the interorbital corridor of the anterior skull base. The technique described by Moe creates an access posterior and lateral to the lacrimal ducts (Figure 2 (Fig. 2)). After inserting a bulb protector, the lacrimal duct probes are inserted in both canaliculi and allow retraction and protection of those structures. The globe is carefully moved in lateral direction by means of a spatula, the caruncula is retracted in lateral direction with small forceps and released with a fine monopolar needle medial along the skin-caruncula border. The incision is extended into the conjunctiva of the upper and lower eyelids and the medial canthal ligament is exposed. The technique described by Raza and Boahene draws the incision in further cranial direction.

Bottom Line: The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors.The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature.Their execution requires an interdisciplinary team approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology, Head & Neck Surgery, University Medicine of Regensburg, Germany.

ABSTRACT
Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach.

No MeSH data available.


Related in: MedlinePlus