J Neurol Surg B Skull Base 2016; 77(06): 439-444
DOI: 10.1055/s-0036-1579544
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Surgical Anatomy of the Medial Wall of the Orbit in 14 Human Cadavers

Juan R. Gras-Cabrerizo
1   Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
Maria Martel-Martin
2   Department of Otolaryngology/Head and Neck Surgery, Hospital de Sant Joan Despí Moisès Broggi de Barcelona, Barcelona, Spain
Jacinto Garcia-Lorenzo
1   Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
Fernando Rodríguez-Álvarez
3   Department of Ophthalmology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
Joan R. Montserrat-Gili
1   Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
Rosa Mirapeix-Lucas
4   Unit of Anatomy and Human Embriology, Universitat Autónoma de Barcelona, Spain
Humbert Massegur-Solench
1   Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
› Author Affiliations
Further Information

Publication History

03 December 2015

20 January 2016

Publication Date:
26 February 2016 (online)


Objective The aim of our study is to present the anatomical landmarks to perform an endoscopic endonasal approach to the medial wall of the orbit (EEAMO).

Material and Methods We performed 14 complete nasal and orbital endoscopic dissections in 7 adult cadaveric heads.

Results The EEAMO provides a surgical corridor between the medial rectus muscle superiorly and the inferior rectus muscle inferiorly .The mean distance between the ethmoidal crest and medial rectus muscle was 1.5 cm (range, 1.3–1.9 cm). The width of the medial rectus muscle was 1.2 cm (range, 1–1.5 cm). The main vascular structure in this retrobulbar space was the ophthalmic artery that crosses over the optic nerve in 86% of the cases. In its intraorbital route, the anterior ethmoidal artery and the ethmoidal nerves were situated inferior to the superior oblique muscle in all cases. The posterior ethmoidal artery was found superior to it. We could identify the inferior division of the oculomotor nerve in this surgical approach.

Conclusions The EEAMO allows adequate exposure of the space between the medial rectus muscle and the inferior rectus muscle. The location of the ethmoidal crest of the palatine bone, and its relationship with the medial rectus muscle, is a useful anatomical landmark for this surgical approach.

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