Transmaxillary Approach for the Resection of Inferior Orbital Venous Varix: Technical Case Instruction

The optimal surgical approach for managing orbital venous varices, particularly those involving the inferior orbit, remains controversial. A transmaxillary approach offers a less invasive alternative to the transnasal approach and avoids disruption of the nasal cavity and medial maxillary wall. This report describes the details of a technique for ligating a venous varix between the inferior rectus and medial rectus muscles that aims to provide relief of symptoms and prevent recurrence.

A 77-year-old man presented with progressive left eye pain that was exacerbated by lying down or straining. Imaging revealed a large enhancing lesion in the left inferior medial orbit, consistent with a venous varix, which was not present on imaging a decade earlier. The patient underwent a single-stage transmaxillary approach, guided by the second division of the trigeminal nerve (V2), to ligate the varix. Postoperative imaging confirmed complete obliteration of the lesion, and the patient experienced immediate relief of symptoms without any described neurological deficits.

The transmaxillary approach for the resection of inferior orbital lesions is a safe and effective technique that can provide excellent clinical outcomes while preserving orbital structures and function.