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Möglichkeiten des chirurgischen Zugangs zur Orbita

Possible surgical approaches to the orbit

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Zusammenfassung

Zur Entfernung von Tumoren und Fremdkörpern aus der Orbita, zur Behandlung von schweren entzündlichen Erkrankungen und zur Reposition von Knochenfragmenten nach Frakturen bzw. zur Rekonstruktion der knöchernen Strukturen der Orbita stehen unterschiedliche chirurgische Zugangswege zur Verfügung. Die zunehmende Kenntnis über die Pathologie und Pathophysiologie einzelner Erkrankungen, die Weiterentwicklung der Mikroskop- und Endoskoptechnik, die besseren Möglichkeiten der präoperativen bildgebenden Darstellung von pathologischen Prozessen, die modernen Möglichkeiten der Rekonstruktion der Orbita sowie die Weiterentwicklung der adjuvanten Therapie hat zu einer verminderten Invasivität und zur Entwicklung der heute i. d. R. angewandten minimalinvasiven chirurgischen Zugangswege zur Orbita geführt. Hierbei ist die operative Therapie häufig eine interdisziplinäre Aufgabe. Zielsetzung der vorliegenden Übersichtsarbeit ist die Beschreibung von heute gängigen chirurgischen Zugangswegen zur Orbita, ihrer Indikation und den potenziellen Komplikationen. Hierbei wird ein besonderes Augenmerk auf die minimalinvasiven Zugangswege gelegt. Die verschiedenen Zugangswege ermöglichen eine 360°-Exposition der Orbitabinnenstrukturen mit dem N. opticus als Zentrum („round the clock access to the orbit“). Die Beschreibung von Tipps und Tricks sowie eine Übersicht der aktuellen Literatur runden die Darstellungen der einzelnen Zugangswege ab.

Abstract

For removal of tumors and foreign bodies from the orbit, for treatment of severe inflammatory diseases, and for repositioning of bone fragments following fractures or during reconstruction of the bony orbit, several different surgical approaches are available. During the past decade, improved understanding of the pathology and pathophysiology of particular orbital diseases, advancements in clinical endoscopy and microscopy, the introduction of modern imaging techniques for preoperative visualization of pathologic findings, modern approaches to orbital reconstruction, as well as developments in adjuvant therapy have led to a reduction in invasiveness and development of the modern minimally invasive surgical approaches to the orbit usually used today. This review article aims to describe several surgical approaches to the orbit that are nowadays commonly applied—frequently in the context of interdisciplinary therapy—as well as their indications and potential complications. Particular attention is paid to minimally invasive approaches. These different surgical approaches allow a 360-degree exposure of the internal orbital structures with the optic nerve at the center (“round the clock access to the orbit”). The review is complemented by hints and tricks for particular approaches, as well as by a review of the latest literature in the field.

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  1. HNO-Klinik, Kopf- und Halschirurgie, regionale plastische Chirurgie, Klinikum Nordstadt, KRH GmbH, Haltenhoffstraße 41, 30167, Hannover, Deutschland

    H.‑J. Welkoborsky

  2. Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland

    S. K. Plontke

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Welkoborsky, H., Plontke, S.K. Möglichkeiten des chirurgischen Zugangs zur Orbita. HNO 66, 812–826 (2018). https://doi.org/10.1007/s00106-018-0570-x

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