Approaches to the orbit: A 360-degree view

Abstract

The orbit contains important neurovascular structures related to the most important human sensory function: the vision. It is located inferiorly to the anterior skull base. The frontal lobes rest on the dura mater that covers the orbital roof. The roof of the maxillary sinus is the orbital fl oor and ethmoid sinus is located medially to the orbit. The medial and inferior parts of the optic canal run in the lateral wall of the sphenoid sinus. The superior and lateral parts of the optic canal are located medially to the anterior clinoid in the intracranial space. The lateral and inferolateral parts of the orbital cavity are formed by the orbital part of the zygomatic bone. The ocular globe is located in the anterior opening of the orbital cavity and is connected superiorly, inferiorly, medially, and laterally to the ocular muscles and posteriorly to the optic nerve. Thus, considering the overlapping medical area where the orbit is located, it is not diffi cult to expect many medical disciplines to be involved in the treatment of orbital lesions. Ophthalmologists, neurosurgeons, otorhinolaryngology-head and neck surgeons, oral and maxillofacial surgeons, and plastic surgeons have been treating orbital lesions in the medical history. However, it is also not diffi cult to assume that the lack of a specifi c “orbital surgery discipline” may lead to suboptimal treatment in some cases. Therefore, the fi eld of orbital surgery has been known as “no man‘s land.” This chapter aims to rationalize the best treatment, the several existing approaches to the orbit, and the criteria for their choice, based on the location and the etiology of the lesion to be treated.