Right Lateral Orbital Decompression
This is Richard Allen at the University of Iowa. This video demonstrates a right lateral orbital decompression.
A lateral canthal incision is performed with the needle tip cautery. One could also approach this procedure through a lateral lid crease incision.
An upper and lower canthlysis is performed.
4-0 silk suture is used for traction.
Dissection is then carried out to the lateral orbital rim.
The periosteum is then incised with the monopolar cautery to expose the bone of the lateral orbital rim.
The periosteum is then elevated from the lateral orbital rim with a Freer periosteal elevator. This is performed intraorbitally to expose the zygoma of the lateral orbital wall.
Dissection is continued posteriorly to expose the greater wing of the sphenoid to the level of the superior orbital fissure.
Bone removal is performed with a cutting burr on a high speed dill.
The bone of the zygoma is removed posterior to the orbital rim.
The eye must be kept lubricated during the procedure.
The temporalis fascia is identified lateral to the zygoma bone and burring continues posteriorly to remove the bone of the greater wing of the sphenoid.
This will expose the anterior portion of the greater wing of the sphenoid referred to as the trigone.
Dissection is carried out lateral to the trigone to separate the temporalis fascia from the trigone.
The trigone can then be removed with a combination of front biting Rongeurs and the cutting burr.
The goal here is to remove as much of the greater wing of the sphenoid as possible to fully decompress the orbit laterally. Ideally in this area the dura is exposed to assure maximal decompression.
Hemostasis is obtained with the cautery as well as bone wax.
Fat removal can then be performed by opening the periorbita and exposing the inferior lateral fat compartment.
The fat can be mobilized and excised with the monopolar cautery.
In general, I will only take fat that is easily mobilized. If it is more fibrotic I tend to be more conservative in my excision due to bleeding concerns.
During the excision hemostasis should be obtained with monopolar and bipolar cautery.
This demonstrates an additional patient with excision of the inferior lateral fat pad.
Again, usually the fat will come relatively easily a demonstrated here, or it will be more fibrotic in which case I will be more hesitant to be aggressive.