31 - Transorbital Techniques to Frontal Sinus Diseases

Abstract

Transorbital approaches to frontal sinus diseases offer an alternative to pure endonasal approaches, combining the desirable aspects of classic external approaches and the more contemporary endonasal approaches. Because the thin superior and medial walls of the orbit are intimately associated with the frontal sinus, osteotomy windows in the fronto-orbital complex offer a direct surgical corridor to frontal sinus pathologies. There are four main technical aspects to transorbital frontal sinus surgery: soft-tissue exposure of the fronto-orbital bone complex, creation of a mini-orbitofrontal bone window, management of the targeted pathology, and reconstruction. These four technical components are performed in a minimally invasive manner over short working distances with bimanual dissection in a coplanar fashion augmented or enhanced with endoscopes or surgical microscopes.