Abstract
In the past years, endoscopic techniques have raised an increasing interest to perform minimally invasive accesses to the orbit, resulting in excellent clinical outcomes with inferior morbidities and complication rates. Among endoscopic approaches, the transantral endoscopic approach allows us to create a portal to the orbital floor, representing the most straightforward access to lesions located in the inferior orbital space. However, if endoscopic surgery provides enhanced magnified vision of the anatomy in a bloodless field, then it has several impairments compared with classic open surgery, owing to restricted operative spaces. Virtual surgical planning and anatomical computer-generated models have proved to be of great importance to plan endoscopic surgical approaches, and their role can be widened with the integration of surgical navigation, virtual endoscopy simulation, and augmented reality (AR). This study focuses on the strict conjugation between the technologies that allow the virtualization of surgery in an entirely digital environment, which can be transferred to the patient using intraoperative navigation or to a printed model using AR for pre-surgical analysis. Therefore, the interaction between different software packages and platforms offers a highly predictive preview of the surgical scenario, contributing to increasing orientation, awareness, and effectiveness of maneuvers performed under endoscopic guidance, which can be checked at any time using surgical navigation. In this paper, the authors explore the transantral approach for the excision of masses of the inferior orbital compartment through modern technology. The authors apply this technique for masses located in the inferior orbit and share their clinical results, describing why technological innovation, and, in particular, computer planning, virtual endoscopy, navigation, and AR can contribute to empowering minimally invasive orbital surgery, at the same time offering a valuable and indispensable tool for pre-surgical analysis and training.
Highlights
Technological development represented a powerful impulse in the way surgeons changed their attitude toward surgical approaches
To be eligible for transmaxillary endoscopic surgery, patients had to fulfill the following inclusion criteria: the presence of an intraorbital mass located over the orbital floor, absence of sinusitis or maxillary sinus hypoplasia, radiological features suggestive for benignancy or, at least, evidence of well-defined boundaries of the lesion
Concerning orbital floor reconstruction, only in two patients, the orbital floor was entirely removed and was suitable for reconstruction, while in the other three patients, it broke into several pieces; the bone dowel from the transmaxillary portal had to be used
Summary
Technological development represented a powerful impulse in the way surgeons changed their attitude toward surgical approaches. In orbital surgery, this meant moving from traditional transcutaneous incisions to an increasing application of minimally invasive techniques in order to excise pathological masses. Modern maxillofacial surgery continues to benefit from technological improvement, which has led to a deep change in the conceptual approach to the preoperative study of the patient, including simulation and training for individual cases. Modern medical software has the power to create entirely virtual environments with a high degree of correspondence to reality, including the possibility to perform accurate modeling of structures using multiple imaging techniques for both bone and soft tissues. Design and animation software can replicate complex combined movements of objects, including deformations, and provide the user with the possibility to place multiple cameras, which can be seen through and animated following a pre-defined path, allowing to simulate a fully endoscopic view for each surgical maneuver [4]
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