Transnasal Endoscopic Approach to Orbital and Sino-Orbital Lesions Cairo University Experience

The orbital and sino-orbital lesions were managed via an external frontoethmoidectomy and lateral rhinotomy or even craniofacial approach which allow thorough exposure and excellent access but carry high incidence of postoperative morbidity. The transnasal endoscopic approach gives a better panoramic view with increased illumination and magnifications. Such visualization provides a potential for more complete tumor removal with less impact on eye function and very low rate of complications. Materials and Methods: Fifty one patients with sinoorbital and medially placed orbital lesions admitted and operated endoscopically by a combined ENT and ophthalmology team from January 2006 to March 2009 were included in this study. Their preoperative and postoperative signs, symptoms, outcomes and radiologic data as well as their operative details were collected and analyzed. Results: Among those 51 patients the majority of cases were inflammatory (26 patients) followed by neoplasms (16 patients) mainly of sinuses extending to the orbit followed by thyroid orbitopathy (7 patients) and finally two traumatic cases. The final outcome was favorable as a whole, zero mortality, one unilateral loss of vision, and good control of pathology with only 11.8% recurrence rate (6 patients), 4 of them required reintervention. The mean follow-up period was 12 months. Conclusion: The transnasal endoscopic surgical technique for orbital and Sino-orbital lesions is a minimally invasive alternative to traditional invasive approaches for selected patients and can achieve favorable outcome with very low morbidity. More practice and time are required to increase our skills and experience to master this approach.