Coronal Approach Research Articles

Infratemporal inflammatory myofibroblastic tumour with orbital extension

Inflammatory myofibroblastic tumour (IMT) is a rare distinctive neoplasm of intermediate biological potential with a predilection for the abdominopelvic region and lung of children and young adults. It is histologically composed of spindle cells (myofibroblasts) in a myxoid to collagenous stroma with a prominent inflammatory infiltrate composed primarily of plasma cells and lymphocytes. Its pathogenesis is controversial. Arising most commonly in the lungs, only two cases of histopathologically confirmed IMT originating from the infratemporal and pterygopalatine fossae have been documented in the literature. Neither had orbital involvement. We now report the first case of IMT originating from the infratemporal fossa with orbital extension in a previously well 31-year-old woman. The patient presented with a 5-month history of intermittent right-sided headaches, progressive trismus and right lower lid swelling. She then developed right proptosis, diplopia and paraesthesia in the ophthalmic and maxillary divisions of her trigeminal nerve. Magnetic resonance imaging showed a soft tissue mass occupying most of the right infratemporal fossa with extension into pterygopalatine fossa and orbit. Provisional diagnosis from an open biopsy was nodular fasciitis. She underwent surgical debulking of the infratemporal fossa and lateral orbit through a coronal and trans-oral approach with trans-zygomatic access via total zygomatic osteotomy. Review of intraoperative specimens revised the diagnosis to IMT. Further management included systemic corticosteroids and adjuvant radiotherapy.

Nasal encephalocele: Endoscopic excision with anesthetic consideration

Objective Nasal encephalocele may presents as a nasal mass, its treatment is surgical and it should be done early in life. When removal is indicated, there are multiple surgical approaches; including lateral rhinotomy, a transnasal approach and a coronal flap approach. However, the treatment of a basal intranasal encephalocele using transnasal endoscopic approach could obviates the possible morbidity associated with other approaches. The aim of this study was to evaluate the efficacy of endoscopic removal of intranasal encephalocele, also to document the role of anesthetist in the operative and postoperative periods. Methods Nine cases with nasal encephalocele were included in this study; CT and/or MRI were used in their examination. The lesions were removed via transnasal endoscopic approach. Preoperative evaluation, intervention and postoperative follow-up were presented with discussion of anesthesia used for those children. Results The lesions of all patients were removed successfully with no recurrence through the follow-up period of at least 21 months. No cases showed morbidity or mortality intra- or post-operatively. Conclusions Endoscopic excision of intranasal encephalocele is an effective method with high success rate. Anesthetist plays an important role in the operative and postoperative period, even during the endoscopic follow up; sedation of the children is usually needed.

Efficacy of Transcaruncular approach to reconstruct isolated medial orbital fracture

Traditional approaches used to repair medial orbital wall fracture include transcutaneous incision such as advocated by Killian and Lynch, or coronal approach. Transcaruncular approach provides an anatomically safe and efficient alternative, allowing generous exposure without the cutaneous scar. Patients presenting with medial orbital wall fractures were identified through the trauma database over a 5year period. Data of twelve consecutive patients who presented with isolated medial wall fracture and treated via a transcaruncular approach were analysed. The extent of the injury, operative and follow up details were documented. There were ten male patients and two female patients. On computed tomography, vertical defect ranged from 8 to 16mm (mean 12mm) and longitudinal defect ranged from 14 to 31mm (mean 22mm). All but three patients were followed up for 9months postoperatively. Two patients were assessed as having a slightly enlarged caruncle on the operated side, but neither patient was aware of this. Of the 2 patients who complained of diplopia, only one had objective restriction beyond 30° of abduction from primary gaze. Transcaruncular approach allows satisfactory exposure for repair of isolated medial orbital wall fracture. It is an anatomically safe and efficient technique, with superior cosmetic result. Postoperative morbidity is minimal and follow up data demonstrates no permanent complications.

Orbital surgery – a two year audit of practice in a craniofacial centre

Background: The surgical techniques and materials used in orbital reconstructive surgery vary widely. The choice of methodand material for a given case often depend on the preferences and experience of the surgeon. Periodic audit of practice isdesirable to evaluate the successes and failure in a center and to compare experiences with other centers.Objective: This study was undertaken to review the indications, surgical approaches, methods and materials used for orbitalreconstruction/recontouring and the incidence and type of complications of the surgery at our centre.Materials and method: The clinic database was explored to retrieve the records of patients who had orbital surgery betweenMay 1, 2005 and April 30, 2007. The required information were retrieved and tabulated to review the current indications,techniques and outcome of orbital surgery at the center.Result: There were 11 patients involved in the audit including 9 males and 2 females within the age range of 10-60 years, meanage of 25.6 + SD 13.1 years. Trauma was the most frequent indication for surgery, the coronal and transconjunctiva approach tothe orbits were favoured and cranial bone graft and Goretex were the preferred materials for reconstruction. Ocular and nonocular postoperative complications were observed. Many of the patients involved had delayed primary or secondary interventionin which case the quality of treatment outcome was affected and further operations were required to correct residual symptomsand complicationsConclusion: Although, there are many complex techniques and esoteric materials being employed worldwide, the approach inthis center is a simplistic one with preference for autogeneous calvarial bone graft and use of Gore-Tex where alloplastic materialwas considered adequate. These principles have been adopted with considerable success.

Revision reduction malarplasty with coronal approach

Although reduction malarplasty is one of the most popular aesthetic surgical procedures in Asia, there have been a few reports of complications or unfavourable results. A poor understanding of the repositioning vector of the malar segment or improper fixation can result in unsatisfactory outcomes, such as non-union or inferolaterally displaced malunion of the malar complex. The authors present some revision malarplasty cases of patients with unfavourable or complicated outcomes to emphasise the importance of accurate repositioning and firm fixation of the malar complex in reduction malarplasty. A total of 20 patients underwent revision malarplasty by the coronal approach after an unfavourable primary reduction malarplasty. The major complaints included cheek drooping, depression, asymmetry and overcorrection. After repositioning the inferolaterally displaced malar complex to the appropriate position and obtaining bone-to-bone contact, rigid fixation was performed with a plate and screw. The calvarian bone was grafted to the bony gap. Midface and forehead lifts were also performed when indicated. Most patients had satisfactory results without severe complications. Two patients required a secondary revision due to asymmetry and non-union. Three patients developed frontal palsies, which were all temporary. Precise repositioning of the malar complex and firm fixation are essential for reduction malarplasty. The coronal approach is recommended when encountering unfavourable results or complications because it offers a wide surgical field for repositioning and fixation of the malar complex.

Experience in the Management of Frontal Sinus Fractures

International guidelines for frontal sinus fractures, dealing with the indication of surgical treatment, obliteration of the frontal sinus, drainage, and cranialization, may differ.In this work, we describe our experience with frontal traumas, analyzing indications, type of treatment, and outcomes by reviewing all data of 112 patients treated for frontal fractures at the Department of Maxillo-Facial Surgery, Università degli studi di Roma Sapienza.We reviewed all clinical and surgical records of patients with traumatic frontal injury treated from 1997 to September 2008. Patients presenting displaced fractures of the anterior wall of the frontal sinus were treated through skin laceration, if existing, or through a coronal approach and fixed with rigid internal devices. Patients with fracture of the posterior wall of the frontal sinus underwent frontal sinus cranialization with galea pericranium pedicled flap to prevent eventful septic complications.Follow-up controls documented that 98 of 112 patients showed no neurologic impairment, no symptoms of cerebrospinal fluid leak, and no other complications after 6 months and 1 and 5 years when follow-up was possible.In the international literature, there is wide agreement about indications dealing with displaced fractures of the anterior wall, although there is a lively debate about posterior wall treatment. In our 10-year experience, the protocol we carried out showed satisfying outcomes, in particular, on the morphofunctional recovery and aesthetic results.

New Mini-Osteotomy of the Infraorbital Nerve in Bony Decompression for Endocrine Orbitopathy

Endocrine orbitopathy is a systemic complex disease that involves the orbital contents. The symptoms are exophthalmos and correlated. The surgical techniques used to correct this condition can be fat decompression by the Olivari technique, 3-wall bony decompression, or the combination of these 2 surgical strategies, the ancillary procedure. Fat decompression is indicated when the intraconal and extraconal fat tissue is increased, whereas bony decompression is used in the presence of extraocular muscle involvement, associated with a normal quantity of intraconal-extraconal fat. Surgical techniques include the transconjunctival approach and ostectomy of the medial wall (when possible through endoscopy), orbital floor, and lateral wall of the orbit.Complications of this type of intervention are often represented by sensitivity disorders of the second branch of the trigeminal nerve, compressed by the intraorbital contents when they prolapse into the sinus. Possible sensitivity disorders are paresthesia, anesthesia, hypoaesthesia, dysesthesia, and hyperesthesia.The innovation introduced by the first author in 2007 consists of a mini ostectomy around the infraorbital foramen with removal of bone fragment. This determines relaxation of the nerve and makes easier the descent toward the sinus, allowing a larger expansion of the orbit contents. The absence of compression significantly reduces the sensitive complications. After treatment of the basic disease, surgical indications should be given according to the Werner classification. Fat decompression with the coronal approach is almost entirely abandoned for the transconjunctival approach, which allows adequate exposure of the lower orbit.The use of mini ostectomy of the infraorbital foramen combined with a 3-wall bony expansion showed a significant reduction of sensitive complications that often cause patient discomfort.

Versatility of the Coronal Approach in Maxillofacial Surgery

ABSTRACT The coronal approach, also known as bi-temporal approach, is one of the most versatile surgical approaches to the zygomatic arch and the mid-facial skeleton. Excellent access is gained to the mid-face by this approach, and it also has a very less number of complications. It is esthetically also excellent, because most of the surgical scar is hidden within the hairline. When the incision is extended into the preauricular area, the surgical scar is inconspicuous. In this article, we attempt to describe the approach, and present our own experience in using it at our centre.

Anatomic Concepts for Brow Lift Procedures

Brow lifting became a component of the facialplasty procedure 45 years ago, and the original brow-lifting technique incorporating a coronal incision approach is still practiced by many surgeons today. Over the past 15 years, however, the endoscope-assisted procedure and the limited incision, nonendoscopic techniques have evolved as alternate procedures for brow lifting. The level of artistry in performing any brow lift technique is raised when the surgeon acquires knowledge of upper facial anatomy and integrates that knowledge into a working concept of the aging process of the upper face. This article presents one surgeon's concepts of the process that culminate in the typical appearance of the aged upper face. The same understanding of upper facial anatomy that can be called upon to explain the steps in this aging process can also be applied to the technical steps of any foreheadplasty procedure. Those anatomic structures that play a role in this process are examined here. The typical appearance of the aged upper face is the product of muscle action and gravitational forces acting on the unique anatomy of the human face. Interestingly, the appearance of the typical aged upper face exhibits much the same characteristics as one might observe in the face of an individual experiencing the emotions of sadness or grief. It is an inappropriate facial expression of sadness or grief that most often motivates the patient to schedule a consultation with the plastic surgeon. Any of the brow lift procedures used in current clinical practice can provide a successful cosmetic result in selected patients if the procedure incorporates technical steps based on sound anatomic principles.

Superior Cerebellar Artery – A Potential Pitfall in Transcranial Posterior Cerebral Artery Insonation

Transcranial color-coded duplexsonography (TCCD) of the posterior cerebral artery (PCA) is commonly performed in an axial midbrain insonation plane. The proximal PCA is easily identified as a vessel, originating from the top of the basilar artery (BA). However, the initial segment of the superior cerebellar artery (SCA) also originates from the top segment of the BA and runs in parallel. Therefore, it is possible to confuse the two vessels. The aim of our study is to anatomically differentiate the proximal PCA and SCA by means of TCCD in the coronal plane using a transtemporal approach and to analyze and compare their flow responses during a visual stimulus paradigm. 60 subjects without a relevant vascular pathology and with a good temporal bone window were examined. The distal BA, the proximal PCA and the SCA were insonated using a coronal insonation plane and identified by their anatomical relationship. The visible length was measured and the blood flow velocities were recorded at rest and during visual stimulation. The identification and differentiation of both vessels was successful in 101 of 120 hemispheres (84.2 %). The PCA systolic flow velocities at rest and during visual stimulation were 58.4 +/- 11 and 71.8 +/- 13 cm/sec (23.6 % increase), while the SCA velocities were 50.7 +/- 12 and 53.5 +/- 13 cm/sec, respectively (5.8 % increase). The difference was significant (p < 0.001). Using the coronal transtemporal insonation approach, TCCD makes it possible to identify and distinguish the proximal PCA and SCA. Our study is the first to provide a systematic ultrasound assessment of the SCA and includes data on normal flow velocities and reactivity to a visual stimulus.

Small Versus Coronal Incision Orbital Decompression In Graves’ Orbitopathy

Ideally the planning of decompression surgery should be adequate to the severity of the orbitopathy, its possible “lipogenic” or “myopathic” variants, the patient’s specific orbital osteology and possible previous surgeries. Due to surgeon’s experience and local traditions, however, a standardized rather than a tailored approach is often offered to the patient. An inferior fornix and/or upper skin crease incision can be used for infero medial and/or lateral, bony and/or fat decompression. As an alternative the swinging eyelid technique, offering an adequate access to the bony orbit and to the orbital fat compartments is a versatile technique that can virtually be used as a standard approach for the greatest majority of patients needing decompression surgery. Orbital decompression by coronal incision is an invasive technique and for this not to be used as a standard approach to orbital decompression. Nevertheless, it is not to be abandoned as it can be an additional tool in surgeons’ hands when dealing with patients who can better benefit out of a particular, tailored rather than a standardised approach. Many are the circumstances in which this may happen. Major complications associated with the coronal approach have been mainly described in small series, where only a few patients per year were operated. In this respect it is therefore unavoidable to emphasize that each technique has its own learning curve and it may be difficult to differentiate the effects of each technique from the experience of the surgeon.

Coloration noire des os du crâne et de la face

We report the case of a patient with a craniofacial black bone disease. This was discovered accidentally during a coronal approach. A 38-year-old patient was referred to our unit for facial palsy having appeared 10 years before. Rehabilitation of the facial palsy was performed with a lengthening temporal myoplasty and lengthening of the upper eyelid elevator. An unusual black color of the skull was observed at incision of the coronal approach. Subperiostal dissection of skull and malars confirmed the presence of a black bone disease. A postoperative history revealed minocycline intake (200mg per day) during 3 years. This craniofacial black bone disease was caused by minocycline intake. The originality of this case is to see directly the entire craniofacial skeleton black. This abnormal pigmentation may affect various organs or tissues. Bone pigmentation is irreversible unlike that of the mouth mucosa or of the skin. This abnormal pigmentation is usually discovered accidentally.

Transcranial Color-Coded Sonography Successfully Visualizes All Intracranial Parts of the Internal Carotid Artery Using the Combined Transtemporal Axial and Coronal Approach

Visualization of the intracranial internal carotid artery (ICA) with transcranial color-coded sonography (TCCS) by using the transtemporal coronal plane has been described previously. Because this approach is limited to the vertical running ICA segments, we investigated the feasibility of using TCCS to visualize all intracranial ICA segments by adding the transtemporal axial approach to the coronal plane. Subjects with excellent transtemporal acoustic windows were examined by TCCS by using standardized axial and coronal planes. Identification rate, flow velocities, pulsatility and resistance indices, and length (as visible in color-coded power mode) were determined. A total of 120 intracranial ICAs from 60 subjects were investigated. By switching between the axial and coronal insonation planes, all intracranial segments of the ICA could be investigated in 100% of subjects-with the exception of the horizontal part of the petrosal ICA, which was identified in 96.7% of subjects. TCCS becomes a reliable tool in investigating all parts of the intracranial ICA by adding the transtemporal axial approach to the coronal plane.

A study on coronal incision for treating zygomatic complex fractures

To study the value of coronal incisions for treating zygomatic complex fractures and evaluate the advantages, indications and complications associated with it. In this prospective study, 12 patients were randomly selected regardless of age, sex requiring open reduction and internal fixation of communited zygomatic complex fractures with or without other associated fractures of the midface. Patients were all treated by coronal approach for open reduction and internal fixation of fracture of the zygomatic complex. Other local incisions were used if required. In all cases postoperative complications were relatively minor except in one case were the temporal branch of facial nerve weakness persisted at 3 months. Whereas 5 cases reported with slight weakness of the temporal branch of the facial nerve which resolved at the end of 3 months. The time taken for exposure of the fracture site via the coronal incision had a mean of 28.7 minutes. There were no cases of flap infection and just 1 case of stitch abscess reported. The same case later reported with a hypertrophic scar formation of greater than 0.5cm at 3months. In all other cases scar formation was negligible and well hidden within the hairline. There were no reported cases of paraesthesia at the operated site or hollowing of the temporal fossa. The coronal incision provides excellent access to the zygomatic arch and zygomatic complex, aiding in good anatomical reduction and also has the added advantage of the scar hidden in the hairline. It also has disadvantages like long operating time, risk of facial nerve injury, scarring in patients with male pattern baldness, paraesthesia of operated site etc. Therefore the incision should be judiciously used and not overused and indications strictly applied.

A systematic review of outcomes following surgical decompression for dysthyroid orbitopathy

To systematically review and compare the surgical outcomes of orbital decompression for dysthyroid orbitopathy. Data sources used were PubMed, EMBASE, and Cochrane search for English-language literature from January 1990 to April 2008, combined with manual review of citations within article bibliographies. Citations acquired from the targeted search were filtered independently by two researchers. Relevant articles were reviewed to obtain information including interventions and outcome measures. Articles were then assigned level-of-evidence grades as defined by the Oxford Centre for Evidence-Based Medicine. A total of 516 citations were generated from which 135 abstracts were regarded as potentially relevant. After other relevant articles identified from the bibliography and duplicate articles excluded, 56 studies were available for analysis. Fifty studies were identified as level 4 and six as level 3 evidence. A total of 2,315 patients were pooled, from which 4,176 orbits were decompressed. Fifteen different surgical techniques were broadly identified. The most common surgical indication was cosmesis. Decompression by combined transpalpebral-endoscopic technique resulted in the highest average reduction in postoperative proptosis. The largest improvement in visual acuity was after coronal approach orbital decompression. The overall complication rate was 9.3%. The most significant complications were vision loss and cerebral vascular accident. The highest complication rate was associated with combined endoscopic and transpalpebral decompression. There are myriad techniques in practice for decompressing the orbit, but no one technique has yet to achieve consistently good outcome and low complication rates. The reporting of outcomes should conform to a minimum dataset. Laryngoscope, 2009.

Removal of a Maxillary Third Molar Accidentally Displaced Into the Infratemporal Fossa via Intraoral Approach Under Local Anesthesia: Report of a Case

The surgical removal of impacted maxillary third molars is a procedure routinely carried out by dentists and oral surgeons, and it is usually associated with low rates of complications and morbidity. 1 Gulbrandsen S.R. Jackson I.T. Turlington E.G. Recovery of a maxillary third molar from the infratemporal space via a hemicoronal approach. J Oral Maxillofac Surg. 1987; 45: 279 Abstract Full Text PDF PubMed Scopus (37) Google Scholar , 2 Dawson K. MacMillan A. Wiesenfeld D. Removal of a maxillary third molar from the infratemporal fossa by a temporal approach and the aid of image-intensifying cineradiography. J Oral Maxillofac Surg. 1993; 51: 1395 Abstract Full Text PDF PubMed Scopus (22) Google Scholar These complications frequently include fracture of the tuberosity, tooth root fracture, perforation of the maxillary sinus, prolapse of the buccal fat pad, and displacement of the roots or tooth into the maxillary sinus, all of which may be easily managed. 2 Dawson K. MacMillan A. Wiesenfeld D. Removal of a maxillary third molar from the infratemporal fossa by a temporal approach and the aid of image-intensifying cineradiography. J Oral Maxillofac Surg. 1993; 51: 1395 Abstract Full Text PDF PubMed Scopus (22) Google Scholar , 3 Sverzut C.E. Trivellato A.E. Lopes L.M. et al. Accidental displacement of impacted maxillary third molar: A case report. Braz Dent J. 2005; 16: 167 Crossref PubMed Scopus (23) Google Scholar Although the displacement of an entire tooth into the infratemporal fossa was once considered a rare complication, 3 Sverzut C.E. Trivellato A.E. Lopes L.M. et al. Accidental displacement of impacted maxillary third molar: A case report. Braz Dent J. 2005; 16: 167 Crossref PubMed Scopus (23) Google Scholar it has been reported more frequently in the literature in the last 4 decades. 1 Gulbrandsen S.R. Jackson I.T. Turlington E.G. Recovery of a maxillary third molar from the infratemporal space via a hemicoronal approach. J Oral Maxillofac Surg. 1987; 45: 279 Abstract Full Text PDF PubMed Scopus (37) Google Scholar , 2 Dawson K. MacMillan A. Wiesenfeld D. Removal of a maxillary third molar from the infratemporal fossa by a temporal approach and the aid of image-intensifying cineradiography. J Oral Maxillofac Surg. 1993; 51: 1395 Abstract Full Text PDF PubMed Scopus (22) Google Scholar , 4 Dimitrakopoulos I. Papadaki M. Displacement of a maxillary third molar into the infratemporal fossa: Case report. Quintessence Int. 2007; 38: 607 PubMed Google Scholar , 5 Winkler T. von Wowern N. Odont L. et al. Retrieval of an upper third molar from the infratemporal space. J Oral Surg. 1977; 35: 130 PubMed Google Scholar , 6 Oberman M. Horowitz I. Ramon Y. Accidental displacement of impacted maxillary third molars. Int J Oral Maxillofac Surg. 1986; 15: 756 Abstract Full Text PDF PubMed Scopus (44) Google Scholar , 7 Grandini S.A. Barros V.M. Salata L.A. et al. Complications in exodontia—Accidental dislodgment to adjacent anatomical areas. Braz Dent J. 1993; 3: 103 PubMed Google Scholar , 8 Patel M. Down K. Accidental displacement of impacted maxillary third molars. Br Dent J. 1994; 23: 57 Crossref Scopus (44) Google Scholar , 9 Paoli J.R. Gence E. Vives P. et al. Removal through the coronal approach of the upper wisdom teeth Apropos of a case of bilateral migration into the temporal fossa [in French]. Rev Stomatol Chir Maxillofac. 1995; 96: 392 PubMed Google Scholar , 10 Durmus E. Dolanmaz D. Kucukkolbsi H. et al. Accidental displacement of impacted maxillary and mandibular third molars. Quintessence Int. 2004; 35: 375 PubMed Google Scholar , 11 Orr II, D.L. A technique for recovery of a third molar from the infratemporal fossa: Case report. J Oral Maxillofac Surg. 1999; 57: 1459 Abstract Full Text PDF PubMed Scopus (25) Google Scholar

Temporal Dissection Technique That Prevents Temporal Hollowing in Coronal Approach

Temporal hollowing after lateral facial skeletal exposure via a coronal approach is not uncommon. This is caused by injury to the superficial temporal fat pad. However, to prevent facial nerve injury at the zygomatic arch, incision of the superficial layer of the temporalis fascia (TF) and exposure of the temporal fat pad are accompanied with most coronal approaches. Here we introduce our method of dissection of the suprasuperficial layer of the TF without exposure of the temporal fat pad and report on its safety and efficacy. Temporal dissection just superficial to the superficial layer of the TF was performed to the superior border of the zygomatic arch. After identifying the zygomatic arch, an incision was made at the posterosuperior aspect of the arch, when exposure of the arch was necessary for access to the lateral skeleton. From 1989 to 2008, 522 patients undergoing craniofacial surgery via coronal approach were analyzed retrospectively. No patient developed temporal hollowing. However, 14 patients (2.7%) developed frontal weakness immediately postoperatively, and 2 of them had permanent paresis. The frequency of this motor morbidity was low compared with that of other reports. Preservation of the temporal fat pad in coronal approach is essential for the prevention of temporal hollowing, and for this, we recommend suprasuperficial layer of TF dissection.

Endoscopic Repair of Anterior Table Frontal Sinus Fractures

Frontal sinus fractures account for 5 to 15% of all maxillofacial injuries. The majority of these fractures are the result of high-velocity injuries such as motor vehicle accidents, assaults, and sporting events. The treatment algorithm for complex frontal sinus fractures is controversial due to the associated risks of brain injury, meningitis, cerebrospinal fluid fistula, and mucocele formation. However, mild to moderately displaced anterior table fractures carry a relatively low risk of long-term morbidity and are generally treated as aesthetic deformities. Unfortunately, the coronal approach for repair of these injuries is associated with significant sequelae including a large scar, alopecia, paresthesias, and, uncommonly, facial nerve injury. These sequelae may result in a greater cosmetic deformity than does the initial injury. Consequently, an endoscopic approach to these injuries has recently been described. The advantages of endoscopic surgery include limited incisions, reduced soft tissue dissection, reduced risk of alopecia, minimal risk of postoperative paresthesias, reduced hospital stay, and improved patient selection. Disadvantages include a moderate learning curve, narrow field of view, lack of depth perception, and the fact that the surgeon cannot operate bimanually without an assistant.

Reconstruction of Bony Orbit Using Endoscope and Polyethylene with Embedded Titanium for a Patient with Postoperative Enophthalmos

Enophthalmos means displacement of the globe into the bony orbit backward, and usually downward. In post-traumatic enophthalmos, the mechanisms that determine the globe position can be the enlargement of the orbital cavity, the herniation of orbital fat into the maxillary sinus, fat atrophy, loss of ligament support, and scar contracture. It can be reconstructed through several approaches such as transconjunctival, canthotomy, lower eye lid, coronal approach, and by using bone, cartilage, and alloplastic materials. The authors report a case of postoperative enophthalmos reconstructed through subciliary and transnasal endoscopic approaches using porous polyethylene with embedded titanium.

Surgical treatment of tumors of the lacrimal gland by coronal approach

The purpose of this research is examination of the clinical characteristics, the preparation and the course of the operative treatment of the tumors of the lacrimal gland. The following article presents four cases where a lateral orbitotomy with coronal approach is used. A complete excision of the tumor is conducted. The postoperative observation of the diseased varies between 18 and 114 months, and includes an analysis of the results. Scripta Scientifica Medica 2008; 40(2): 161-163