Left Medial Orbital Decompression
This is Richard Allen at the University of Iowa. This video demonstrates a left medial wall decompression through a transcaruncular incision.
An Incision is made with the Westcott scissors between the caruncle and the plica.
Steven scissors are then used to bluntly dissect in the direction of the posterior lacrimal crest.
A malleable retractor can then be used to visualize the medial orbital wall.
A Desmarres retractor can be placed medially in order to assist in the exposure.
A Freer periosteal elevator can then be used to make an incision through the periosteum of the medial orbital wall.
The periosteum is then elevated and the initial goal of this dissection is to identify the anterior ethmoidal neurovascular bundle. This lies superior along the fronto-ethmoidal suture.
This dissection is then demonstrated using an endoscope through the same incision.
The Freer periosteal elevator is used to make an incision through the periosteum and the then the periosteum can be elevated from the medial orbital wall just posterior to the posterior lacrimal crest.
Elevation then proceeds along the medial orbital wall until the anterior ethmoidal neurovascular bundle is identified. Which is right in this area.
Dissection then proceeds posterior until the posterior ethmoidal neurovascular bundle is identified.
This is demonstrated in this area.
The bone is then fractured inferior to these two neurovascular structures.
This will expose the ethmoid sinus where the sinus mucosa should be removed.
This is removed to the face of the sphenoid sinus. Depending on the goal of your decompression, varying amounts of bone can be removed.
Attention is then directed inferiorly with the endoscope through an orbital floor incision.
Through this approach, the orbital floor is identified where a fracture has already been placed for the decompression.
Through this incision, the medial decompression can also be visualized. The goal here is to preserve an anterior strut between the medial and floor decompression.
The strut is identified in this area here, and the posterior portion of the strut which is demonstrated by the loose bone can be removed so that just the anterior portion of the strut remains. This is in order to prevent globe dystopia post-operatively.