2016 Section 5 Green Book

Endoscopic OCH resection

TABLE 3. Intraoperative characteristics

TABLE 3. Continued

n

%

n

%

Team

None

17

73.9

ENT

23

100.0

Mucosal graft

5

21.7

Ophthalmology

6

26.1

Fascia lata

1

4.3

Neurosurgery

5

21.7

Packing None

Use of image guidance Yes

12

52.2

19

82.6

Nonabsorbable

10

43.5

No

4

17.4

Absorbable

1

4.3

Approach

a Middle turbinate swing: temporary displacement of middle turbinate. b Transseptal suture: a suture or vessel loop is passed above and below the medial rectus muscle belly, allowing for medial retraction through a septotomy. ENT = ear, nose, throat. TABLE 4. Postoperative characteristics

Single nostril

16

69.6

Middle turbinectomy

8

34.8

Binarial

6

26.1

Septal window

4

17.4

n

%

Middle turbinate swing a

1

4.3

Eye position

Number of hands/surgeons 2/1

No change/symmetric

18

78.3

7

30.4

Enophthalmos

5

21.7

3/2

10

43.5

Proptosis

0

0.0

4/2

6

26.1

Diplopia None

Medial rectus retraction None

14

60.9

12

52.2

Worse

6

26.1

Double ball probe retraction

3

13.0

Better

3

13.0

Transseptal suture retraction b

2

8.7

Vision

Blunt dissection

2

8.7

Improved

12

52.2

Medial rectus detached

1

4.3

No change

11

47.8

Hemostasis Bipolar

Worse

0

0.0

13

56.5

None

6

26.1

exposed via a single nostril using 2 or 3 hands. In con- trast, intraconal lesions were approached using a variety of both single-nostril and binarial techniques. Although the majority of intraconal OCHs were resected using a 3-handed or 4-handed approach, 31.25% were resectable using only 2 hands. This finding suggests that when per- forming preoperative planning for tumors located lateral to the medial rectus muscle, strong consideration should be given to providing access for an assisting surgeon, al- though this is not an absolute requirement. Two of the major challenges associated with endoscopic surgery within the orbit are the presence of copious, mobile, orbital fat and the possibility of bleeding immediately adjacent to critical neurovascular structures including the oculomotor and op- tic nerves. Extraconal orbital fat can be judiciously shrunk with bipolar electrocautery to improve visualization; how- ever, the safety of removing intraconal fat is controversial. Orbital fat was removed without complication in 21.7%

Warm water

4

17.4

Monopolar

0

0.0

Orbital fat removal None

18

78.3

Extraconal

5

21.7

Intraconal

0

0.0

Resection

Complete

17

73.9

Partial

2

8.7

Biopsy

2

8.7

Decompression

2

8.7

Reconstruction

( Continued )

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