眼窩病変に対する内視鏡下経副鼻腔眼窩アプローチ法の適応と限界

DOI 参考文献12件
  • 唐木 將行
    香川大学医学部耳鼻咽喉科頭頸部外科
  • 森 望
    香川大学医学部耳鼻咽喉科頭頸部外科

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  • The adaptation and limitation of endoscopic endonasal transparanasal approach to the posterior orbit

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The posterior orbit contains a number of important and vulnerable structures, including the optic nerve, the ophthalmic artery and vein, the ocular muscles and their motor nerves, which makes the surgical access to any lesions in this region quite difficult. Transfrontal, transfront-ethmoidal and transmaxillary procedures have the disadvantage of causing possible injuries to a number of normal structures, whereas the endoscopic transparanasal approach is a minimally invasive surgical procedure that proven to be effective for the orbital retrobulbar lesions. We experienced nine cases such as cavernous hemangioma, carcinoid metastasis, hematoma, and Wegener's granulomatosis. We examined the adaptation and limits of the procedure based on the experience gained from these nine cases.<br>Endoscopic endonasal ethmoidectomy and antrostomy clearly visualize the medial-inferior part of the orbit as well as the apex of the orbit. A slightly larger portion of the bone than the size of the lesion in the medial wall of the orbit including the ethmoid-maxillary plate should be removed. <br>Medial or lateral orbital subperiosteal lesions can be removed using the endoscopic endonasal transparanasal procedure with low risk of operative complications to the orbital structures. This procedure is not impossible in the treatment of upper subperiosteal liquid lesions. The endoscopic endonasal transparanasal approach is a very useful procedure for the treatment of orbital subperiosteal lesions. However, orbital tumors inside the muscle cone are accompanied serious complications. Careful consideration needs to be given to the appropriateness of adopting this procedure in such cases.

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  • 頭頸部外科

    頭頸部外科 19 (1), 13-18, 2009

    特定非営利活動法人 日本頭頸部外科学会

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