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Maximal, three-wall, orbital decompression through a coronal approach

R A Goldberg1, D A Weinberg, N Shorr

  • 1Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, UCLA School of Medicine, USA.

Ophthalmic Surgery and Lasers
|October 23, 1997
PubMed
Summary
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This study demonstrates that a coronal approach for orbital decompression significantly reduces proptosis in thyroid-related orbitopathy. Removing the deep lateral orbital wall allows for greater volume expansion and improved cosmetic outcomes.

Area of Science:

  • Ophthalmology
  • Plastic Surgery
  • Endocrinology

Background:

  • Traditional lateral orbital decompression offers limited volume expansion.
  • Removing the deep sphenoid wing bone can provide significant additional soft tissue expansion.
  • A coronal approach allows access to the deep portion of the sphenoid wing.

Purpose of the Study:

  • To report the experience with maximal, three-wall orbital decompressions via a coronal approach.
  • To evaluate the effectiveness of this technique in reducing proptosis in patients with thyroid-related orbitopathy.

Main Methods:

  • Twenty patients with stable Graves' disease orbitopathy underwent maximal, three-wall orbital decompressions through a coronal approach.
  • Techniques included thinning, augmentation, or repositioning of the lateral orbital rim and sculpting the bone over the lacrimal fossa.

Related Experiment Videos

  • Medial and inferior orbital decompression was facilitated by elevating the medial canthal tendon and lacrimal sac.

    • Main Results:

    • Twenty coronal orbital decompressions were performed over 44 months.
    • Retrodisplacement of up to 6 mm was achieved without rim augmentation, and up to 9 mm with rim augmentation.
    • Seven cases involved lateral rim advancement.

    Conclusions:

    • The deep lateral orbital wall, accessed via a coronal approach, offers substantial volume expansion for orbital decompression.
    • This technique can achieve significant proptosis reduction, with the lateral wall being a primary approach.
    • The coronal approach provides access to all four orbital walls for comprehensive orbital decompression.