Endoscopic endonasal approach to the lateral orbital apex: case report

Although the medial and inferior orbital apex are considered safely accessible using the endonasal endoscopic approach, the lateral apex has been considered unsafe to access since the optic nerve lies between the surgeon and the pathology. The authors present the case of a 4-year-old girl with recurrent rhabdomyosarcoma attached to the lateral rectus muscle located lateral and inferior to the optic nerve in the orbital apex. The tumor was totally resected through an endoscopic endonasal transmaxillary transpterygoidal approach using a 45° endoscope. A gross-total resection was achieved, and the patient's vision was unchanged. This procedure is a safe, minimal-access alternative to open procedures in selected cases and provides evidence that increases the applicability of the endonasal endoscopic approach to reach the lateral compartment of the orbital apex.