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Transorbital Approach to the Pterygopalatine Fossa Following Exenteration in Cadaveric Models.

Jessica Y Tong1,2,3, Jeffrey Sung2,3, Rowan Valentine3,4,5

  • 1South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Ophthalmic Plastic and Reconstructive Surgery
|April 8, 2026
PubMed
Summary

A transorbital approach to the pterygopalatine fossa after orbital exenteration is feasible. This technique allows access to tumors extending into the orbital apex and pterygopalatine fossa, such as squamous cell carcinoma.

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Area of Science:

  • Neurosurgery
  • Ophthalmology
  • Head and Neck Surgery

Background:

  • Orbital exenteration is a radical surgical procedure for advanced orbital malignancies.
  • Accessing the pterygopalatine fossa after exenteration presents surgical challenges.

Purpose of the Study:

  • To describe a novel transorbital surgical approach to the pterygopalatine fossa.
  • To evaluate the feasibility of this approach following total orbital exenteration.

Main Methods:

  • A cadaveric dissection study was performed on 5 head specimens (10 orbits).
  • The technique involved infraorbital nerve identification, posterior osteotomy, and maxillary sinus wall removal.
  • Visualization of the pterygopalatine segment of the trigeminal nerve (V2) and internal maxillary artery was achieved.

Main Results:

  • The orbital floor defect measured approximately 13.2 mm x 13.5 mm x 7.9 mm x 8.3 mm.
  • A bony defect of 10.6 mm x 11.4 mm was created to access V2.
  • A larger defect (17.1 mm x 12.2 mm) was required to access the internal maxillary artery.

Conclusions:

  • Transorbital approaches to the pterygopalatine fossa are feasible after orbital exenteration.
  • This approach is indicated for orbital tumors with extension to the orbital apex and pterygopalatine fossa.
  • Squamous cell carcinoma is an example of a tumor where this approach may be beneficial.