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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

“Classical” supratarsal incision (dashed black line); the authors prefer the supra-supratarsal incision (actual incision line) which allows enhanced exposure of the anterior skull base with excellent and generally invisible scarring.
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Figure 5: “Classical” supratarsal incision (dashed black line); the authors prefer the supra-supratarsal incision (actual incision line) which allows enhanced exposure of the anterior skull base with excellent and generally invisible scarring.

Mentions: The superior lid crease approach is also called upper eyelid approach. Moe et al. and Boahene et al. describe the skin incision in the supratarsal fold. The authors of the present paper favor an incision about 7–12 mm above the supratarsal fold. This “supra-supratarsal incision” remains located in the thin skin of the upper eyelid and avoids the skin of the eyebrow that is clearly different with regard to texture and color. The higher supra-supratarsal incision corresponds to the superior incision of a cosmetic blepharoplasty, just like the supratarsal incision it generally remains without visible scars (Figure 5 (Fig. 5)). The access corridor to the anterior skull base becomes larger due to the more superior placement of the incision, a lateral extension to the crow’s feet is still possible. The mainly sub-periosteal access to the orbital roof is medially limited by the trochlea and laterally be the canthal ligament [1], [2].


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

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

“Classical” supratarsal incision (dashed black line); the authors prefer the supra-supratarsal incision (actual incision line) which allows enhanced exposure of the anterior skull base with excellent and generally invisible scarring.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: “Classical” supratarsal incision (dashed black line); the authors prefer the supra-supratarsal incision (actual incision line) which allows enhanced exposure of the anterior skull base with excellent and generally invisible scarring.
Mentions: The superior lid crease approach is also called upper eyelid approach. Moe et al. and Boahene et al. describe the skin incision in the supratarsal fold. The authors of the present paper favor an incision about 7–12 mm above the supratarsal fold. This “supra-supratarsal incision” remains located in the thin skin of the upper eyelid and avoids the skin of the eyebrow that is clearly different with regard to texture and color. The higher supra-supratarsal incision corresponds to the superior incision of a cosmetic blepharoplasty, just like the supratarsal incision it generally remains without visible scars (Figure 5 (Fig. 5)). The access corridor to the anterior skull base becomes larger due to the more superior placement of the incision, a lateral extension to the crow’s feet is still possible. The mainly sub-periosteal access to the orbital roof is medially limited by the trochlea and laterally be the canthal ligament [1], [2].

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