13 Lateral Orbitotomy Orbital lesions, depending on their location and relationship with the intra-orbital structures, can be approached through different surgical routes (transcranial or trans-orbital). The lateral orbitotomy, also known as Krönlein approach, and its further modifications allow for an easy reach of intra-orbital lesions located in the superior, lateral, and inferior intraconal compartments as well as pathologies of the lateral aspect of the orbital apex. Lateral orbitotomy takes advantage of a direct approach to orbital content, avoiding potential complication of a transcranial or direct transorbital route. • Orbital intra-conal and extra-conal lesions. • Lesions of the lateral aspect of the orbital apex. • Position: The patient is positioned supine with the head fixed with a horseshoe head holder. • Body: The head is slightly elevated, to facilitate the venous backflow. • Head: The head is turned 45° to the contralateral side. • Neck: The neck is slightly extended (about 20°). • The zygoma must be the highest point in the surgical field. • Italic “S” skin incision (Fig. 13.1) ◦ Starting point: Incision starts at the lateral third of the eyebrow, just above the orbital rim. ◦ Course: Incision line runs posteriorly and inferiorly toward the postero-superior (temporal) border of the zygomatic bone. ◦ Ending point: It ends at the zygomatic-temporal suture. • Frontal branch of the facial nerve. • Orbicularis oculi muscle. • Supraorbital nerve and vessels. • Lateral canthal ligament. • Temporal fascia and periorbit ◦ Superficial temporal muscle fascia is incised, avoiding transecting underlying muscle fibers. ◦ Periorbit is dissected from the inner surface of the lateral wall of the orbit.
13.1 Introduction
13.2 Indications
13.3 Patient Positioning
13.4 Skin Incision
13.4.1 Critical Structures
13.5 Soft Tissue Dissection (Figs. 13.2, 13.3)
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