Advertisement

Japanese Journal of Ophthalmology

, Volume 61, Issue 4, pp 361–367 | Cite as

Upper fornix approach combined with a superior lateral cantholysis: a minimally invasive approach to the superonasal intraconal space

  • Ho-Seok SaEmail author
  • Ji Won Seo
  • Sunah Kang
Clinical Investigation

Abstract

Purpose

To present a new minimally invasive approach to the deep superonasal orbit.

Methods

This retrospective study reviewed seven consecutive patients who underwent orbital surgery using an upper conjunctival fornix approach combined with a superior lateral cantholysis for tumors in the superonasal intraconal space. Charts were reviewed for demographic, radiological, clinical, and surgical data including surgical outcome and morbidities for each patient.

Results

Six benign tumors of the superonasal intraconal orbit were successfully exposed and removed using this approach, and one malignant tumor was biopsied for diagnosis. Histopathology revealed cavernous haemangioma (3 cases), solitary fibrous tumor (2 cases), schwannoma (1 case), and diffuse large B cell lymphoma (1 case). Visual acuity and ocular motility were unchanged or improved in all cases. There were no visible scars or other complications related to this approach.

Conclusion

The upper fornix approach combined with a superior lateral cantholysis is a novel technique that provides safe and excellent exposure of the deep superonasal orbit. In addition, it avoids the unnecessary morbidity of upper lid splitting, medial rectus muscle detachment, or bone removal.

Keywords

Intraconal space Orbitotomy Superonasal orbit Transconjunctival approach 

Notes

Acknowledgements

Steven J. Yoon, M.D., Specialty Eye Care, Glendale, CA, USA for manuscript editing.

Conflicts of interest

H-S. Sa, None; J. W. Seo, None; S. Kang, None.

Supplementary material

Video. 1 Surgical steps of upper fornix approach combined with a superior lateral cantholysis are described. Surgical video and clinical course of illustrative case are also included (MP4 32729 kb)

References

  1. 1.
    Smith B. The anterior surgical approach to orbital tumors. Trans Am Acad Ophthalmol Otolaryngol. 1966;70:607–11.PubMedGoogle Scholar
  2. 2.
    Krönlein RU. Zur pathologie und operative behandlung der dermoidzysten der orbita. Beitr Klin Chir. 1889;4:149–63 (in German).Google Scholar
  3. 3.
    Harris GJ, Perez N. Surgical sectors of the orbit: using the lower fornix approach for large, medial intraconal tumors. Ophthal Plast Reconstr Surg. 2002;18:349–54.CrossRefPubMedGoogle Scholar
  4. 4.
    Sinnreich Z, Nathan H. The ciliary ganglion in man (anatomical observations). Anat Anz. 1981;150:287–97.PubMedGoogle Scholar
  5. 5.
    Stallard HB. A plea for lateral orbitotomy: with certain modifications. Br J Ophthalmol. 1960;44:718–23.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Yan J, Wu Z. Cavernous hemangioma of the orbit: analysis of 214 cases. Orbit. 2004;23:33–40.CrossRefPubMedGoogle Scholar
  7. 7.
    Park SJ, Yang JW. The transconjunctival approach a minimally invasive approach to various kinds of retrobulbar tumors. J Craniofac Surg. 2013;24:1991–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Cho KJ, Paik JS, Yang SW. Surgical outcomes of transconjunctival anterior orbitotomy for intraconal orbital cavernous hemangioma. Korean J Ophthalmol. 2010;24:274–8.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Pelton RW, Patel BC. Superomedial lid crease approach to the medial intraconal space: a new technique for access to the optic nerve and central space. Ophthal Plast Reconstr Surg. 2001;17:241–53.CrossRefPubMedGoogle Scholar
  10. 10.
    Shorr N, Baylis HI, Goldberg RA, Perry JD. Transcaruncular approach to the medial orbit and orbital apex. Ophthalmology. 2000;107:1459–63.CrossRefPubMedGoogle Scholar
  11. 11.
    Kersten RC, Kulwin DR. Vertical lid split orbitotomy revisited. Ophthal Plast Reconstr Surg. 1999;15:425–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Dutton JJ. The eyelids and anterior orbit. Atlas of clinical and surgical orbital anatomy. 2nd ed. Philadelphia: Elsevier Saunders; 2011. p. 129–64.CrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2017

Authors and Affiliations

  1. 1.Department of Ophthalmology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
  2. 2.Department of Ophthalmology, Ilsan Paik HospitalInje University College of MedicineGoyangKorea

Personalised recommendations