Transnasale Chirurgie der Orbita

Abstract

The endonasal surgery has a branch in the transnasal orbital surgery. For this transnasal approach the anterior skull base, the medial and infero-medial orbita, the orbital apex with the optical nerve and the sphenoid sinus are within reach. In all primary and secondary malignant lesions with extension into the orbita, the transnasal biopsy is of importance for diagnosis, particularly in metastasis to the orbit and pseudo-tumors. Benign lesions like mucoceles and osteomas are accessible and fully removable. Good results have been obtained in endonasal orbital decompression and inhomogeneous space occupying intraorbital lesions like bleedings. Among the orbital traumatism, with restrictions fractures of the medial orbital wall, medial orbital floor and foreign bodies could be operated. The transnasal approach is not indicated in all diseases, which are situated mostly intraconally, supraorbitally and lateral of the bulbus as well as in tumors with intracranial extension. In summary, the transnasal orbital approach has its place as helpful addition to the transfacial and transcranial techniques and can even replace them in certain selected indications.