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J Neurol Surg B Skull Base 2012; 73(02): 132-138
DOI: 10.1055/s-0032-1301398
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anatomy of the Inferior Orbital Fissure: Implications for Endoscopic Cranial Base Surgery

Juan Carlos De Battista
1   Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute, UC College of Medicine, Cincinnati, Ohio
,
Lee A. Zimmer
1   Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute, UC College of Medicine, Cincinnati, Ohio
2   Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati (UC) Neuroscience Institute, UC College of Medicine, Cincinnati, Ohio
,
Philip V. Theodosopoulos
1   Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute, UC College of Medicine, Cincinnati, Ohio
,
Sebastien C. Froelich
1   Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute, UC College of Medicine, Cincinnati, Ohio
,
Jeffrey T. Keller
1   Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute, UC College of Medicine, Cincinnati, Ohio
3   Mayfield Clinic, Cincinnati, Ohio
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Publikationsverlauf

22. Juni 2011

11. Oktober 2011

Publikationsdatum:
06. Februar 2012 (online)

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Abstract

Considering many approaches to the skull base confront the inferior orbital fissure (IOF) or sphenomaxillary fissure, the authors examine this anatomy as an important endoscopic surgical landmark. In morphometric analyses of 50 adult human dry skulls from both sexes, we divided the length of the IOF into three segments (anterolateral, middle, posteromedial). Hemotoxylin- and eosin-stained sections were analyzed. Dissections were performed using transnasal endoscopy in four formalin-fixed cadaveric cranial specimens (eight sides); three endoscopic approaches to the IOF were performed. IOF length ranged from 25 to 35 mm (mean 29 mm). Length/width of the individual anterolateral, middle, and posteromedial segments averaged 6.46/5, 4.95/3.2, and 17.6/ 2.4 mm, respectively. Smooth muscle within the IOF had a consistent relationship with several important anatomical landmarks. The maxillary antrostomy, total ethmoidectomy approach allowed access to the posteromedial segment of the fissure. The endoscopic modified, medial maxillectomy approach allowed access to the middle and posterior-medial segment. The Caldwell-Luc approach allowed complete exposure of the IOF. The IOF serves as an important anatomic landmark during endonasal endoscopic approaches to the skull base and orbit. Each of the three segments provides a characteristic endoscopic corridor, unique to the orbit and different fossas surrounding the fissure.

Keywords

skull base - endoscope - inferior orbital fissure - orbit - pterygopalatine fossa
 

  • References

  • 1 Al-Nashar IS, Carrau RL, Herrera A, Snyderman CH. Endoscopic transnasal transpterygopalatine fossa approach to the lateral recess of the sphenoid sinus. Laryngoscope 2004; 114 (3) 528-532
    CrossrefPubMedGoogle Scholar
  • 2 Anand VK, Schwartz TH eds. The endoscopic, transsphenoidal, transplanum, transtuberculum approach to the suprasellar cistern. In: Anand VK, Schwartz TH, eds. Practical Endoscopic Skull Base Surgery. San Diego: Plural Publishing; 2007: 105-122
    Google Scholar
  • 3 Burkart CM, Theodosopoulos PV, Keller JT, Zimmer LA. Endoscopic transnasal approach to the clivus: a radiographic anatomical study. Laryngoscope 2009; 119 (9) 1672-1678
    CrossrefPubMedGoogle Scholar
  • 4 Cavallo LM, Cappabianca P, Galzio R, Iaconetta G, de Divitiis E, Tschabitscher M. Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomic study. Neurosurgery 2005; 56 (2, Suppl) 379-389 , discussion 379–389
    CrossrefPubMedGoogle Scholar
  • 5 Cavallo LM, Messina A, Gardner P , et al. Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations. Neurosurg Focus 2005; 19 (1) E5
    PubMedGoogle Scholar
  • 6 de Divitiis E, Cappabianca P, Cavallo LM. Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions. Neurosurgery 2002; 51 (3) 699-705, discussion 705–707
    CrossrefPubMedGoogle Scholar
  • 7 Jho HD, Ha HG. Endoscopic endonasal skull base surgery: Part 1—The midline anterior fossa skull base. Minim Invasive Neurosurg 2004; 47 (1) 1-8
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 8 Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 2005; 19 (1) E6
    PubMedGoogle Scholar
  • 9 Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R. The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery 2005; 57 (1, Suppl) E213 , discussion E213
    CrossrefPubMedGoogle Scholar
  • 10 Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 2007; 106 (3) 400-406
    CrossrefPubMedGoogle Scholar
  • 11 Schwartz TH, Fraser JF, Brown S, Tabaee A, Kacker A, Anand VK. Endoscopic cranial base surgery: classification of operative approaches. Neurosurgery 2008; 62 (5) 991-1002, discussion 1002–1005
    CrossrefPubMedGoogle Scholar
  • 12 Stamm AC, Pignatari SS, Vellutini E. Transnasal endoscopic surgical approaches to the clivus. Otolaryngol Clin North Am 2006; 39 (3) 639-656, xi
    CrossrefPubMedGoogle Scholar
  • 13 Alfieri A, Jho HD, Schettino R, Tschabitscher M. Endoscopic endonasal approach to the pterygopalatine fossa: anatomic study. Neurosurgery 2003; 52 (2) 374-378, discussion 378–380
    CrossrefPubMedGoogle Scholar
  • 14 Fortes FS, Sennes LU, Carrau RL , et al. Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach: development of a surgical instruction model. Laryngoscope 2008; 118 (1) 44-49
    CrossrefPubMedGoogle Scholar
  • 15 Magro F, Solari D, Cavallo LM , et al. The Endoscopic endonasal approach to the lateral recess of the sphenoid sinus via the petrygopalaitine fossa; Comparison of endoscopic and radiological landmarks. Neurosurgery 2006; 59 (suppl 4) ONS-237-ONS-243
    PubMedGoogle Scholar
  • 16 Gönül E, Erdogan E, Düz B, Timurkaynak E. Transmaxillary approach to the orbit: an anatomic study. Neurosurgery 2003; 53 (4) 935-941, discussion 941–942
    CrossrefPubMedGoogle Scholar
  • 17 Har-El G. Combined endoscopic transmaxillary-transnasal approach to the pterygoid region, lateral sphenoid sinus, and retrobulbar orbit. Ann Otol Rhinol Laryngol 2005; 114 (6) 439-442
    CrossrefPubMedGoogle Scholar
  • 18 Herzallah IR, Elsheikh EM, Casiano RR. Endoscopic endonasal study of the maxillary nerve: a new orientation. Am J Rhinol 2007; 21 (5) 637-643
    CrossrefPubMedGoogle Scholar
  • 19 Kamel RH. Transnasal endoscopic surgery in juvenile nasopharyngeal angiofibroma. J Laryngol Otol 1996; 110: 962-968
    PubMedGoogle Scholar
  • 20 Cavallo LM, Messina A, Gardner P , et al. Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations. Neurosurg Focus 2005; 19 (1) E5
    PubMedGoogle Scholar
  • 21 Ong BC, Gore PA, Donnellan MB, Kertesz T, Teo C. Endoscopic sublabial transmaxillary approach to the rostral middle fossa. Neurosurgery 2008; 62 (3, Suppl 1) 30-36 , discussion 37
    CrossrefPubMedGoogle Scholar
  • 22 Jian XC, Wang CX, Jiang CH. Surgical management of primary and secondary tumors in the pterygopalatine fossa. Otolaryngol Head Neck Surg 2005; 132 (1) 90-94
    CrossrefPubMedGoogle Scholar
  • 23 Martínez Ferreras A, Rodrigo Tapia JP, Llorente Pendás JL, Suárez Nieto C. [Endoscopic nasal surgery for pterigopalatine fossa schwannoma]. Acta Otorrinolaringol Esp 2005; 56 (1) 41-43
    PubMedGoogle Scholar
  • 24 Kafadar AM, Tanriverdi T, Canbaz B, Kuday C. Trigeminal neuroma with extracranial extension: the 31st case. Minim Invasive Neurosurg 2006; 49 (4) 230-233
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 25 Kamel RH. Transnasal endoscopic surgery in juvenile nasopharyngeal angiofibroma. J Laryngol Otol 1996; 110 (10) 962-968
    PubMedGoogle Scholar
  • 26 Teresi LM, Lufkin RB, Viñuela F , et al. MR imaging of the nasopharynx and floor of the middle cranial fossa. Part II. Malignant tumors. Radiology 1987; 164 (3) 817-821
    CrossrefPubMedGoogle Scholar
  • 27 Yu Q, Wang P, Shi H, Luo J, Sun D. The lesions of the pterygopalatine and infratemporal spaces: Computed tomography evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85 (6) 742-751
    CrossrefPubMedGoogle Scholar
  • 28 Aziz KM, Froelich SC, Cohen PL, Sanan A, Keller JT, van Loveren HR. The one-piece orbitozygomatic approach: the MacCarty burr hole and the inferior orbital fissure as keys to technique and application. Acta Neurochir (Wien) 2002; 144 (1) 15-24
    CrossrefPubMedGoogle Scholar
  • 29 Hakuba A, Liu S, Nishimura S. The orbitozygomatic infratemporal approach: a new surgical technique. Surg Neurol 1986; 26 (3) 271-276
    CrossrefPubMedGoogle Scholar
  • 30 Martins C, Li X, Rhoton Jr AL. Role of the zygomaticofacial foramen in the orbitozygomatic craniotomy: anatomic report. Neurosurgery 2003; 53 (1) 168-172, discussion 172–173
    CrossrefPubMedGoogle Scholar
  • 31 Shimizu S, Tanriover N, Rhoton Jr AL, Yoshioka N, Fujii K. MacCarty keyhole and inferior orbital fissure in orbitozygomatic craniotomy. Neurosurgery 2005; 57 (1, Suppl) 152-159 , discussion 152–159
    CrossrefPubMedGoogle Scholar
  • 32 Sanan A, Abdel Aziz KM, Janjua RM, van Loveren HR, Keller JT. Colored silicone injection for use in neurosurgical dissections: anatomic technical note. Neurosurgery 1999; 45 (5) 1267-1271, discussion 1271–1274
    CrossrefPubMedGoogle Scholar
  • 33 Müller H. Über einen glatten Muskel in der Augenhöhle des Menschen und der Säugetiere. Z wis Zool 1858; 9: 541
    PubMedGoogle Scholar
  • 34 Lang J. Clinical Anatomy of the Head, Neurocranium, Orbit, and Craniocervial Regions. Springer Verlag; 1983
    CrossrefGoogle Scholar
  • 35 Rahman M, Richter EO, Osawa S, Rhoton Jr AL. Anatomic study of the infraorbital foramen for radiofrequency neurotomy of the infraorbital nerve. Neurosurgery 2009; 64 (5, Suppl 2) 423-427 , discussion 427–428
    CrossrefPubMedGoogle Scholar
  • 36 Zimmer LA, Hart C, Theodosopoulos PV. Endoscopic anatomy of the petrous segment of the internal carotid artery. Am J Rhinol Allergy 2009; 23 (2) 192-196
    CrossrefPubMedGoogle Scholar
  • 37 Whitnall SE. Part I Osteology. The bone forming the orbit, its relations, and the accessory air-sinuses of the nose. The anatomy of the human orbit and accessory organs of vision. 2nd ed. Oxford University Press; 1932: 41-43 , 86–89
    Google Scholar
  • 38 Choi J, Park HS. The clinical anatomy of the maxillary artery in the pterygopalatine fossa. J Oral Maxillofac Surg 2003; 61 (1) 72-78
    CrossrefPubMedGoogle Scholar
  • 39 Rodríguez Vázquez JF, Mérida Velasco JR, Jiménez Collado J. Orbital muscle of Müller: observations on human fetuses measuring 35-150 mm. Acta Anat (Basel) 1990; 139 (4) 300-303
    CrossrefPubMedGoogle Scholar
  • 40 Rodríguez-Vázquez JF, Mérida-Velasco JR, Arráez-Aybar LA, Jiménez-Collado J. Anatomic relationships of the orbital muscle of Müller in human fetuses. Surg Radiol Anat 1998; 20 (5) 341-344
    CrossrefPubMedGoogle Scholar
  • 41 Dutton JJ. Atlas of Clinical and Surgical Orbital Anatomy. Philadelphia: Saunders; 1994: 100-101
    Google Scholar
  • 42 Waitz G, Wigand ME. Results of endoscopic sinus surgery for the treatment of inverted papillomas. Laryngoscope 1992; 102 (8) 917-922
    CrossrefPubMedGoogle Scholar
  • 43 Zimmer LA, Theodosopoulos PV. Anterior skull base surgery: open versus endoscopic. Curr Opin Otolaryngol Head Neck Surg 2009; 17 (2) 75-78
    CrossrefPubMedGoogle Scholar
  • 44 Theodosopoulos PV, Guthikonda B, Brescia A, Keller JT, Zimmer LA. Endoscopic approach to the infratemporal fossa: anatomic study. Neurosurgery 2010; 66 (1) 196-202 , discussion 202–203
    CrossrefPubMedGoogle Scholar