Endoscopic Transnasal Orbital Decompression

TLDR

Orbital decompression for dysthyroid orbitopathy has traditionally been performed externally or transantrally, but intranasal endoscopes have enabled a transnasal approach to medial and inferior orbital walls. The authors performed transnasal decompressions on 13 orbits in eight patients, including simultaneous bilateral lateral orbitotomies in five patients and Walsh‑Ogura decompressions with lateral orbitotomies in two orbits. Transnasal decompression alone reduced Hertel measurements by an average of 4.7 mm, and when combined with lateral orbitotomy, improved them by 5.7 mm (transnasal) and 4.5 mm (Walsh‑Ogura); visual acuity improved in three of four optic neuropathy patients and all with exposure keratopathy, demonstrating comparable efficacy to traditional methods while avoiding external morbidity. Published in Arch Otolaryngol Head Neck Surg 1990;116:275‑282.

Abstract

• Orbital decompression for dysthyroid orbitopathy has traditionally been performed through either an external or a transantral approach. The advent of intranasal endoscopes allowed for the development of a transnasal approach for medial and inferior orbital wall decompression. Using this approach, orbital decompressions were performed on 13 orbits in eight patients with severe complicated dysthyroid orbitopathy. Simultaneous bilateral lateral orbitotomies were performed on five patients. Walsh-Ogura decompressions and lateral orbitotomies were performed on two orbits. When combined with lateral orbitotomy, Hertel measurements improved an average of 5.7 mm in orbits decompressed transnasally and 4.5 mm in orbits decompressed with a Walsh-Ogura approach. Transnasal decompression alone improved Hertel measurements an average of 4.7 mm. Visual acuity improved in three of four patients with optic neuropathy, and in all patients with exposure keratopathy. We conclude that the endoscopic transnasal approach provides comparable decompression to traditional methods while avoiding the morbidity of an external ethmoidectomy or Caldwell-Luc antrotomy. (<i>Arch Otolaryngol Head Neck Surg</i>. 1990;116:275-282)