Principles of Orbital Surgery

Abstract

Surgical access for orbital disease has moved away from transcranial approaches towards a variety of regional approaches that utilise incisions along the relaxed skin tension lines or the conjunctiva. However, where disease extends beyond the bony confines of the orbit into the cranium, pterygopalatine fossa, or paranasal sinuses, multidisciplinary management with a neurosurgeon and maxillofacial and/or head-and-neck surgeon is required. Operating within the confined space of the bony orbit carries significant risks of injury to the delicate soft tissues contained within it. While impairment of motor and facial sensory nerves can be reversible, visual loss due to ischaemic optic neuropathy – presumed due to vasospasm – rarely recovers. The six approaches described herein permit access to each region of the orbit. When disease is ill-defined or straddles different areas, combinations of these approaches may aid in visualisation and dissection.