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The most common surgical access techniques employed in patients with orbital floor fractures are associated with a risk of complications, such as implant infection, migration, epiphora, lower eyelid retraction, ectropion, diplopia worsening, retrobulbar hematoma, emphysema, “white-eyed” syndrome, enophthalmia relapse, hypoglobus, and persistent diplopia due to periorbital atrophy. Consequently, alternative access techniques precluding these complications have to be found. To assess the efficacy of transantral approach in the surgical treatment of patients with orbital floor fractures based on results of retrospective analysis of our clinical experience. We performed a retrospective study of medical records and X-ray data of 52 patients with fractures of the floor of the orbit, 18 to 68 years old, treated using transantral approach as described in the article. Titanium plates of special shape were used for orbital floor reconstruction. In 94.2% of the cases, adequate restoration of the floor of the orbit was achieved. It led to regression of the ocular signs. In 4 patients, diplopia remained in extreme gaze positions, which did not require surgical correction. The failed cases were related to incorrect positioning of the plate or fixing screws. No inflammatory complications were observed. Transantral access approach may be a technique of choice in treating patients with orbital floor fractures; it is safe, minimally traumatic, and effective in the early posttraumatic period when the injured area is located in the posterior parts of the floor of the orbit.

Endoscopically assisted transantral approach has been used since more than 2 decades for the repair of orbital floor fractures. Its popularity has increased worldwide as it overcomes most of the disadvantages of traditional techniques such as visible scar, ectropion, entropion, eyelid shortening, and impaired visibility of the posterior edge of the defect. There are different endoscopic approaches for orbital floor repair. In this article, we present our endoscopic surgical technique to repair isolated orbital floor fractures using titanium mesh with a tight-fit fixation. The technique was used in 5 patients, and the minimum postoperative follow time was 3 months. Level of evidence: Level V, therapeutic study.

Orbital floor fracture, especially with constriction of orbital soft tissue, should be reconstructed surgically. Although various approaches to treat the orbital floor have been reported, procedures have not been unified among hospitals or surgeons. Since 2009, we have adopted a procedure combining a transorbital approach via subciliary incision with a transantral approach through upper gingival incision. The combined approach compensates for the shortcomings of each approach, leading to successful reconstruction. It is applicable safely for trapdoor fracture of the orbital floor in children, which more frequently constricts orbital soft tissue and which leaves permanent diplopia. This report retrospectively assessed clinical preoperative findings and postoperative outcomes of patients who received reconstruction of orbital floor fracture with the combined approach in our department from August 2009 through March 2021. Data of 21 patients with orbital floor fracture were analyzed, only one (4.8%) of whom had postoperative diplopia. Specifically, we describe children with trapdoor fracture treated with the combined approach, resulting in complete recovery. The combined approach stands as an excellent procedure for reconstruction of orbital floor fracture in adults and even in children.

Purpose We compared the accuracy of orbital volume correction between the transorbital and transantral reconstructive techniques. Materials and Methods A retrospective cohort study was performed of patients who had undergone repair of isolated, unilateral orbital floor blowout fractures at Legacy Emanuel Hospital from 2013 to 2018. A total of 21 patients were identified and included in the predictor variable cohorts of the transorbital versus transantral repair technique. The outcome variable of orbital volume correction was evaluated by comparing the volume of the postoperative repaired orbits with that of the contralateral noninjured orbits. Additional ordinal variables analyzed included the preoperative orbital defect size and analysis of the transantral cohort stratified by the plating technique used. Data were assessed using analysis of variance and paired t tests. Results A transantral approach was used for orbital repair in 9 patients. In these patients, the postoperative orbital volume in the injured orbit was 2.69% greater than that in the uninjured orbit. The 12 patients who had undergone transantral repair had a postoperative orbital volume in the injured orbit that was 0.56% smaller than that of the uninjured orbit (P = .033). Division of the transantral cohort into 2 different plating techniques identified a less than 1% difference in mean orbital volume correction between the 2 techniques (P = .104). The average defect volume before transorbital repair was 4.87 cm3 compared with 5.22 cm3 for transantral repair (P = .907). Conclusions The results from the present study have shown that the accuracy of orbital volume correction using the transantral approach will be comparable to that of the transorbital approach, as shown by a small, but statistically significant, increased accuracy in the volume correction with the transantral approach. Additional investigation to establish clinical correlations with these findings should be conducted.

Background The treatment of complex orbital floor fractures with extensive orbital prolapse remains a surgical challenge in craniomaxillofacial traumatology and is still controversially discussed. Reduction of orbital tissue via a transcutaneous or transconjunctival approach alone can be very difficult and lead to unsatisfying results. Methods Over a 3-year-period, we enrolled 13 patients who underwent endoscopy-assisted reconstruction of isolated orbital floor fractures via a combined subciliary and transantral approach. Patient data, imaging and ophthalmologic examination were reviewed prospectively. Results Ten patients underwent primary surgical treatment, 3 patients had secondary surgical treatment because of unsatisfactory results of primary surgical intervention. All patients had an uneventful postoperative course without ophthalmologic deterioration, no further surgical procedures were necessary. Conclusions The additional use of an endoscopy-assisted transantral approach provides a reliable treatment modality in selected cases. To our knowledge, this is the only study of patients treated with a combined subciliary and transantral approach. Special emphasis was given to postoperative functional results, a short algorithm for use of an additional transantral endoscopy-assisted approach is presented.

Authors present a case of metallic foreign bodies (part of the hammer) in apex of the orbit in a 57-year-old man. In CT scan it was localized between rectus lateral muscle and optic nerve. We remove it through transantral approach. We discuss about diagnosis and indication to transnasal and transsinusal (trough maxillary and ethmoidal sinuses) approaches to the retrobulbar part of the orbit.

The aim of this case report is to present a case of root fragment removal during planned sinus lift procedure. After failed molar tooth extraction, we chose to retrieve the residual root apex with transantral approach not to damage excessively bone volume. Without changing primary implant rehabilitation purpose, the fragment removal procedure was performed prior to implant placement during necessary sinus lift surgery. Higher visibility of surgical field was achieved. The root fragment residual was removed without an additional surgery appointment avoiding postoperative discomfort. The goal is to underline the importance of being able to change planning during intrasurgical complications. It is most appropriate to operate with safe and simple procedures to reduce surgical discomfort for the patient.

Nasoangiofibroma juvenil (NAFJ) é um tumor incomum que se localiza na região do forame esfenopalatino. A cirurgia combinada à embolização pré-operatória tem sido a opção terapêutica mais empregada nos pacientes com NAFJ sem invasão intracraniana. O objetivo desse estudo é avaliar a viabilidade do tratamento cirúrgico do nasoangiofibroma em pacientes estágios I- III de Fisch, sem uso de embolização pré- operatória. MATERIAL E MÉTODO: Estudo descritivo, retrospectivo, utilizando-se dados de revisão de prontuário de quinze pacientes com NAFJ estágio I a III de Fisch submetidos à cirurgia sem embolização pré-operatória, entre os anos de 2000 e 2005. RESULTADOS: Dos quinze pacientes, sete pacientes foram submetidos à cirurgia endoscópica, quatro via transmaxilar, três via endoscópica e transmaxilar e um via transmaxilar e transpalatina. Seis pacientes necessitaram de hemotransfusão no intra-operatório, com média geral de 1.3 bolsa/paciente. Nenhum caso de mortalidade ou morbidade significativa foi registrado. Onze dos quinze pacientes foram acompanhados por tempo médio de doze meses com taxa de recidiva de 27%. Quatro pacientes perderam seguimento. CONLUSÃO: A ressecção de NAFJ classes I- III foi realizada com segurança em pacientes não-embolizados, com taxa de sangramento intraoperatório, ocorrência de complicações e taxa de recorrência próximas dos valores pesquisados na literatura para pacientes embolizados. Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon tumor of the sphenopalatine foramen. Surgery combined with preoperative embolization has been the treatment of choice for JNA patients without intracranial invasion. This study aims to assess the viability of surgically treating non-embolized patients with JNA (types I-III according to Fisch). MATERIAL AND METHOD: This is a retrospective, descriptive study based on the medical records of 15 patients with histologically confirmed JNA (Fisch’s types I- III), who underwent surgical treatment without pre-op embolization in our institution between 2000 and 2005. RESULTS: Seven of the fifteen patients were approached endoscopically, four through the transantral approach, three were treated with the combined transmaxillary and endoscopic approach, and one with the combined transmaxillary and transpalatal approach. Six patients required intraoperatory blood transfusion, averaging volumes of 1.3 unit/patient. There were no cases of death or significant morbidity. Eleven of the fifteen patients were followed for an average of twelve months and 27% of them relapsed. Four patients did not comply with the follow-up scheme. CONCLUSION: Resection of JNF types I-III was safely completed in non-embolized patients. The observed levels of intraoperative bleeding, occurrence of complications, and rates of recurrence were close to those seen in embolized patients as found in the literature.

Neurilemmomas are benign and slow growing tumours. Neurilemmomas of the pterygopalatine fossa are rare. In this paper we present a case of schwannoma arising in the pterygopalatine fossa with extension into infratemporal fossa and floor of the orbit. A transantral approach was used for excision of the tumor following which the defect in the floor of the orbit was reconstructed with the help of a temporoparietal flap.

Endoscopic transnasal approach is an excellent technique for resecting orbital tumors located inferiorly and/or medially to the optic nerve. The aim of this study was to present four cases of orbital tumor which were, at least in part, resected by an endoscopic transnasal approach and to discuss both indications and limitations of this approach through a comparison of the location and tumor status, including the pathology, of these cases. In two cases with orbital tumor located in a medial-inferior quadrant, we were able to resect it only by an endoscopic transnasal approach. Because we experienced transient diplopia and dyschromatopsia after resecting intraconal tumors, a careful choice for the best approach is suggested in view of the location, size and properties of the tumor. In the third case, with tumor located in an inferior-lateral quadrant, it was eventually resected using a frontal-zygomatic approach because the medial and inferior borders of the tumor could not be identified and the lateral border was beyond the limits of manipulation by an endoscopic transnasal approach. In the last case with possible malignant tumor adhered to the lateral vital, the tumor was resected using a transantral approach. Based on these experiences, we introduce the indications for an endoscopic transnasal resection of orbital tumors.

The transantral approach to orbital decompression remains useful for the management of exophthalmos associated with dysthyroid orbitopathy. However, the risk of postoperative diplopia is a concern. Preservation of the anterior periorbita may help support the orbital contents and decrease the incidence of diplopia.The medical records were reviewed of 15 consecutive patients who underwent 30 transantral orbital decompressions for proptosis associated with dysthyroid orbitopathy. The procedures were completed in standard fashion, including removal of the inferomedial bony strut between the medial orbital wall and the floor. However, stripping of the periorbita was only done posteriorly; the anterior 10 to 15 mm of periorbita were left intact.Six patients had preoperative diplopia that persisted after decompression. Of the nine patients without diplopia preoperatively, none developed diplopia. Proptosis was reduced a mean of 3.5 +/- 2.6 mm.Preservation of the anterior periorbita during transantral orbital decompression reduces the risk of postoperative diplopia. An adequate reduction in proptosis is also achieved.

Objective: Depending on the type of pathology and location, various methods of access have been developed to overcome the obstacle of accessing the orbit. The endoscope provides minimally invasive surgical access to the medial and inferior orbit. Expanding endoscopic access to the lateral orbit transantrally could create a minimally invasive corridor.Method: Using late injected cadavers, endoscopic dissections of the infero-lateral orbit were undertaken. A sublabial transmaxillary ostomy was created and an endoscope was advanced into the sinus. The contents of the orbit were dissected laterally to the inferior optic nerve. Photographic evidence was obtained for review.Results: A 45° endoscope was required to adequately visualize the anatomy. The perpendicular nature of the corridor necessitated the use of angled instrumentation. This also created a challenge as the dissections were completed superiorly. Dissection was found to be facile until revealing the lateral rectus muscle. Proceeding superiorly past...

i l ractures of the orbital floor are common midfacial fractures. lthough conventional approaches such as the subciliary or ransconjunctival approach are usually used for such fracures, the endoscopic transantral approach is safe and reliable n suitably selected patients1 and has recently been used as inimally invasive treatment.1,2 Improvement of ocular movement after the repair of a racture of the orbital floor is generally confirmed by the orced duction test. However, such improvement is more ifficult to assess after the endoscopic transantral approach ithout direct visualisation of soft tissues above the orbital oor, because the assessment depends on the surgeon’s skill nd experience and there are few objective indicators. We eport the use of a dial tension gauge to assess quantitaively the intraoperative improvement of ocular movement fter endoscopic transantral repair of a fracture of the orbital oor. Under general anaesthesia, 5/0 nylon is sutured to the nsertion of the inferior rectus muscle so that the globe is ot injured by the conjunctiva being grasped at the inserion. This procedure is not as traumatic as multiple trials of

Orbital floor blow-out fractures in two patients were surgically repaired. The transconjunctival approach alone was unsuccessful in freeing the entrapped orbital contents, so the transantral approach with the use of antral wall bone graft was also used. The combined approaches produced good results. The transconjunctival approach supplemented with the transantral approach and bone graft may be a useful technique in the repair of orbital floor blow-out fractures.

A 12-year-old boy presented to our emergency department after being shot in the face. A computed tomographic scan revealed a bullet through the posterolateral wall of the maxillary sinus into the right infratemporal area, just adjacent to the skull base. We elected transantral approach with the help of endoscopy and C-arm. The bullet was successfully removed. Little is known on the best strategy for removing the infratemporal foreign body. Our experience in this case provides a safe and effective way for such injury.

The authors report a case of nasal malignant melanoma involving the septum, nasal turbinates and nasopharynx which was approached by lateral rhinotomy combined with an anterior transantral approach with excision of the septum and the lateral wall of the nasal cavity for wide exposure of the tumour. Using this technique complete surgical resection of a large nasal malignant melanoma was achieved with minimal morbidity and good aesthetics. 2011 European Association for Cranio-Maxillo-Facial Surgery.

A case is presented in which periradicular maxillary molar surgery was performed with the transantral approach. Included is a discussion of the related anatomy, physiology, and pathology of the maxillary sinus.

The use of functional endoscopic sinus surgery has been limited typically to management of chronic sinusitis, nasal polyposis, and recurrent acute sinusitis. Antrochoanal polyps (ACPs) traditionally have been resected using a Caldwell-Luc sinusotomy. We used the endoscopic approach, however, in the treatment of five cases of ACP. There was recurrence in one case, but the polyp was successfully removed endoscopically. In the other four cases there has been no evidence of recurrence at a maximum follow-up of 24 months. We believe that transnasal endoscopic antrochoanal polypectomy is an excellent surgical option; there is significantly less postoperative morbidity than with the transantral approach, and rates of complete cure are similar.

We read with interest the article by Radkowski et al 1 concerning angiofibroma. We would agree that the combined transpalatal and transantral approach allows limited access to the superolateral areas of potential tumor spread and that for the more extensive juvenile nasopharyngeal angiofibroma a wider exposure is required. The midfacial degloving incision allows an excellent cosmetic result on the skin, but this approach has the significant disadvantage of destroying the anterior maxillary bone in the lateral alar region, which is of particular importance in the growing facial skeleton and dentition. The authors comment that there was no evidence of disturbance of midface growth in an average follow-up of 6 years; it would be interesting to know the median follow-up and what parameters were used to assess facial growth. Our experience has indicated considerable ipsilateral nasal base collapse with delay or absent eruption of the permanent canine tooth or local abnormalities

A 16-year-old female had had gradually increasing limitation of movement of the jaw for six years.A diagnosis was made of osteoma of the mandibular coronoid process. This was removed via a transantral approach to the pterygopalatine fossa.

A review of 14 patients treated between 1975 and 1979 is reported. The lesions were quite extensive in most of the patients, having extended beyond the nasopharynx in all but one. An extended transantral approach was utilized in nine of the patients to facilitate removal of lateral and superior extensions of tumor. Two of the patients (14%) developed recurrent tumor, one six months and one nine months following treatment. The extended transantral approach appears to be an effective method of approaching the pterygomaxillary extension of the tumor.

Chordoma of the skull base has a poor prognosis because of the proximity of vital structures as well as the difficulty encountered in attempting complete surgical excision. This paper presents a case of massive recurrent chordoma involving the intracranial cavity, nasal cavity, and maxillary antrum. The tumor was debulked and decompressed via a transantral approach to the pterygomaxillary fossa and the base of the skull. This technique is recommended because it achieves immediate decompression and provides a space into which the inevitable regrowth of the tumor may extend.

A nasopharyngeal fibroma which was resistant to radium (advocated by Parish and Pfahler, 1 New and Havens, 2 Mertins 3 and Persky 4 ) and inaccessible for electrolysis (advocated by Delavan 5 and Forster 6 ) was successfully extirpated by the transantral approach developed by Sewall 7 for the removal of the sphenopalatine ganglion. REPORT OF CASE R. S., a boy aged 9 years, was seen on Aug. 27, 1932, because of increasing nasal obstruction, frequent colds, apparently chronic nasal discharge of a few years' duration, frequent mild nosebleed, frequent bronchitis and prolonged fever after colds. The family physician had reported a "growth" in the nose, but the parents had observed no difference between the sides of the nose. Adenotonsillectomy had been done four years ago, after purulent otitis media. Examination of the nose showed the mucosa to be congested on both sides. There was some mucopurulent secretion, especially around the middle meatuses. After shrinkage a large mass "resembling

FRAZIER, three decades ago, expressed the hope that a simple approach might be elaborated for the excision of the sphenopalatine ganglion. He was highly impressed by the beneficial effect derived from an anesthetic drug deposited on or near the ganglion. To his mind, however, the amelioration obtained this way was, unfortunately, temporary; permanent relief from the excruciating pains could be expected only after the sphenopalatine ganglion had been excised. Since the preceding statement goes directly to the theme of this paper, it should not be passed off without some serious reflection. Frazier observed that certain persons during their period of suffering obtained swift and gratifying alleviation when an anesthetic drug was brought into contact with the nasal ganglion. The drug might be carried on a pledget of cotton or on an applicator or might be injected. There were undoubtedly times when the drug was not brought into immediate contact with

Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon tumor of the sphenopalatine foramen. Surgery combined with preoperative embolization has been the treatment of choice for JNA patients without intracranial invasion. This study aims to assess the viability of surgically treating non-embolized patients with JNA (types I-III according to Fisch). Materials And Method: This is a retrospective, descriptive study based on the medical records of 15 patients with histologically confirmed JNA (Fisch’s types I- III), who underwent surgical treatment without pre-op embolization in our institution between 2000 and 2005. Results: Seven of the fifteen patients were approached endoscopically, four through the transantral approach, three were treated with the combined transmaxillary and endoscopic approach, and one with the combined transmaxillary and transpalatal approach. Six patients required intraoperatory blood transfusion, averaging volumes of 1.3 unit/patient. There were no cases of death or significant morbidity. Eleven of the fifteen patients were followed for an average of twelve months and 27% of them relapsed. Four patients did not comply with the follow-up scheme. Conclusion: Resection of JNF types I-III was safely completed in non-embolized patients. The observed levels of intraoperative bleeding, occurrence of complications, and rates of recurrence were close to those seen in embolized patients as found in the literature.

✓ The authors describe the technique of a transantral transsphenoidal approach to the sella turcica. The advantages and potential complications are discussed. This procedure may also be applicable when dealing with tumors of the skull base and orbits.

Cerebrospinal rhinorrhea is a potentially serious symptom due to the risk of an ascending infection, which may produce a fulminant meningitis. Plaster of Paris has been used to obliterate the sphenoidal sinus and posterior ethmoids in five patients with cerebrospinal rhinorrhea. The fistulas were identified by computed cisternography and repaired by a transantral approach using a microsurgical technique, and bone chips, Tisseel and fascia to seal the fistulas. There have been no postoperative problems or leakage in the three patients with fistulas to the sphenoidal sinus. The cerebrospinal rhinorrhea recurred four and six months after operation in the two patients with fistulas to the posterior ethmoids probably due to surgical, technical problems in one patient and to less support by the plaster of Paris, when the fistulas end in this region. However, the described surgical technique seems to be a good alternative for fistulas to the sphenoidal sinus and should be included in our surgical armamentarium.

Our experience with 18 cases of juvenile nasopharyngeal angiofibroma (jna) over a period of 9 years is discussed. All cases were managed surgically: 17 via a transpalatal approach and one case by a combined transpalatal, lateral rhinotomy, and transantral approach. In this series there were two recurrences following primary surgical procedures and these required a second procedure. There were no major complications and all 18 patients are alive. We believe that surgical excision should be the treatment of choice for jna and that radiotherapy should be used adjunctively for cases wherein intracranial extension of the tumors prevents total excision.

• Rapid progression to blindness due to intraorbital hemorrhage following various forms of trauma requires immediate, aggressive intervention, with the potential to restore vision. Orbital decompression via either an external ethmoidectomy or transantral approach is described. The diagnosis, anatomy, and pathogenetic mechanisms relevant to these cases are reviewed. ( Arch Otolaryngol Head Neck Surg 1988;114:801-803)

Endocrine exophthalmos is an entity distinctly different from the ocular involvement associated with thyrotoxicosis. An alteration of normal pituitary gland function is probably the underlying cause of this condition. Once medical measures have failed, orbital decompression may alter deterioration of vision, globe exposure, or the psychological effects of proptosis. Of all the procedures used, the one done by the transantral approach to the bony orbital cage seems to be the most effective and reliable. Optimum overall care of these patients is best achieved by the combined approach of both the otolaryngologist and the ophthalmologist.