Lateral orbitotomy without removal of the lateral orbital rim
J. D. Wirtschafter and A. E. Chu
Department of Ophthalmology, University of Minnesota Medical School, Minneapolis.
Lateral orbitotomy is used for the removal of orbital tumors and for
orbital decompression. Most surgeons make saw cuts through the lateral
orbital rim and remove and rewire the bone. This procedure is
time-consuming and requires repair of the lateral canthal structures. We
describe a technique using an air-driven "acorn-tipped" bur that removes
the posterolateral lip of the frontal process of the zygomatic bone and
effectively straightens the external surface of the lateral orbital wall.
This permits removal of the bone without serious injury to the periorbita.
The technique creates a trapezoidal orbitotomy measuring approximately 20
mm anteroposterior, 25 mm at the anterior vertical base, and 6 mm at the
posterior base. The orbital soft tissues can thus be safely exposed without
removal of the lateral rim. We operated on one patient with cavernous
hemangioma (27 X 21 X 19 mm) and three patients with bilateral Graves'
ophthalmopathy. We discuss anatomic considerations for the prevention of
complications, including injury to the frontotemporal branches of the
facial nerve, injury to the superior head of the lateral pterygoid muscle,
and inadvertent penetration of the dura.
