Related Experiment Video
Updated: Aug 17, 2025
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Tips and tricks for maximising access to the middle cranial fossa using the superior lateral orbital portal
T A Patel1, H Mustak2, D E Lubbe3
1Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA.
Background:
Transorbital endoscopic approaches are becoming increasingly popular for skull base pathologies; the superior lateral orbital portal is one such approach to the middle cranial fossa. This paper provides a technical description that maximises the surgical portal and minimises morbidity.
Technical Description:
A superior lid crease incision is made extending laterally and the orbital rim is exposed. A subperiosteal dissection of the lateral and superior orbit is performed, with elevation of periosteum off Whitnall's tubercle, ligation of the recurrent branch of the middle meningeal artery, and identification of the superior orbital fissure. The lacrimal keyhole is then drilled away. The middle cranial fossa is accessed by drilling posterior to the orbital rim to expose: the temporalis muscle anterior-laterally, the dura of the temporal lobe posterior-laterally, the anterior cranial fossa superiorly and the periorbita medially.
Conclusion:
These surgical steps can maximise the surgical portal and minimise morbidity, with avoidance of injury to surrounding structures.
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