Endoscopic Orbital Decompression: Technical Pearls and Pitfalls of an Evolving Technique

Area of Science:

• Otolaryngology
• Ophthalmology
• Neurosurgery

Background:

• Endoscopic orbital decompression, first described in the early 1990s, is a popular surgical technique.
• It is recognized as a safe and effective method for medial and inferior orbital decompression.

Purpose of the Study:

• To present a preferred technique for endoscopic orbital decompression.
• To highlight key procedural pearls and potential pitfalls.

Main Methods:

• The technique involves an endoscopic wide maxillary antrostomy and sphenoethmoidectomy.
• Resection of the middle turbinate is performed for optimal exposure.
• The medial orbital wall and lamina papyracea are carefully elevated, preserving the periorbita.
• Resection of the orbital floor medial to the infraorbital nerve is conducted.
• Axial incisions are made along the medial orbit and orbital floor, followed by incision of fibrous bands to allow orbital fat prolapse.

Main Results:

• The procedure allows for careful elevation of the lamina papyracea, preserving the periorbita.
• Orbital fat prolapse is observed after fibrous band incision.
• Limited post-extubation bag-mask ventilation is employed to prevent subcutaneous emphysema.

Conclusions:

• Endoscopic orbital decompression offers superior visualization of critical anatomical landmarks compared to open techniques.
• This approach ensures healthy sinus functioning post-procedure and avoids external incisions.
• It is associated with a lower complication rate than traditional open methods.