The Impact of Lateral Rim Osteotomy In Transorbital Approaches: An Anatomical And Clinical Comparative Study

Introduction: The lateral transorbital approach (LTOA) has gained increased recognition, and its applicability has expanded. However, there is still a paucity of data on its effectiveness and advantages compared to the LTOA with lateral orbitotomy, herein denoted as the lateral orbital wall approach (LOWA).

Objective: This study aims to provide an anatomical reappraisal and the authors' clinical experience to compare the two approaches to the orbit and middle cranial fossa (MCF).

Methods: Eight latex-injected cadaveric specimens were used to perform LTOA and LOWA ([Figs. 1] and [2]).

The operative depth of each approach to key anatomical landmarks was measured. Fifty high-resolution computed tomography studies were reviewed to calculate the operative angles. A three-dimensional anatomical model generated through the photogrammetry scanning technique was described. The authors retrospectively reviewed the consecutive cases of 40 patients with orbital and MCF lesions treated by LTOA and LOWA at their institution.

Results: Compared to the LTOA, the LOWA offered shorter operative depths to the optic foramen (p < 0.05), foramen ovale (p < 0.05), and to the junction eyeball-CN II (p = 0.13). It also offered better access to the anterior aspect of the orbit with less orbital content retraction ([Fig. 3]).

The LTOA and LOWA provided statistically different operative angles to key anatomical landmarks in the orbit and MCF (p < 0.05; [Fig. 4]).

In our chart review, 31 patients underwent the LTOA, while 9 underwent the LOWA to treat orbital and MCF lesions. A gross-total resection was achieved in 77.5% of cases, with a higher frequency observed in the LTOA group compared to the LOWA group (p = 0.019). Patients undergoing LOWA experienced postoperative complications related to periorbital nerves, such as frontalis palsy (n = 1) and supraorbital neuralgia (n = 1). Patients undergoing LTOA were more prone to complications associated with intraorbital manipulation (n = 4), including diplopia and ptosis.

Conclusion: Our anatomical and clinical experience data showed that the LTOA can be an effective surgical strategy for addressing orbital apex and MCF lesions. Although the LOWA provides access to the aforementioned areas, it may be more suitable for anterior orbital lesions that require direct access with a wider entry exposure and extensive manipulation of orbital content. Future large clinical studies comparing their outcomes are warranted to further elucidate the optimal clinical indications for these techniques.

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Artikel online veröffentlicht:
07. Februar 2025