Orbital decompression
by Vicky S Khattar, Vicky Bachi T

Jaypee’s Video Atlas of Operative Otorhinolaryngology AND Head & Neck Surgery

by Vicky S Khattar, Bachi T Hathiram
About Video

This compilation of videos demonstrates orbital decompression for a variety of indications. (i) Orbital decompression for a pseudotumor not responding to medication: This video demonstrates the standard steps of surgery followed for an orbital decompression. Incision of the periosteum is, however, not performed in all cases. The decision to perform the latter depends upon the indication. It is important to remember that whenever an orbital decompression is performed for visual compromise, the decompression must extend for a few millimeters beyond the orbital apex. (ii) Orbital decompression for an extraperiosteal orbital abscess of odontogenic origin: This video demonstrates orbital decompression for an extraperiosteal orbital abscess. In such cases, a simple removal of the lamina papyracea will suffice to evacuate the accumulated pus. (iii) Orbital decompression for a post-traumatic subperiosteal orbital hematoma: In subperiosteal collections, such as in this case of an orbital hematoma, the orbital periosteum needs to be incised to evacuate the collection. (iv) Penetrating orbital foreign body: A penetrating foreign body lodged in the ethmoids needs to be removed with utmost care. After performing an ethmoidectomy, the foreign body is gently teased off from its impingements. Due to its trajectory followed during impact, an orbital decompression needs to be done. (v) Post-traumatic medial rectus entrapment syndrome: Medial rectus entrapment can occur following medial orbital blowout fractures with resultant diplopia. An orbital decompression followed by gentle removal of the offending bony fragment will result in a successful outcome. (vi) Post-traumatic medial and inferior orbital blowout: Occasionally, the blowout fracture may be inferior as well as medial. In such cases, an orbital decompression will treat the medial blowout, while the inferior blowout needs to be managed transantrally. After removing the offending bony fragment, the orbital floor may have to be elevated with an inflated Foley’s catheter placed in the maxillary sinus. (vii) Oculoplastic approach for an abscess in the superior compartment of the orbit: Demonstrated here is the standard oculoplastic approach for treating an orbital abscess. This approach may come in handy in very anteriorly placed orbital abscesses, but carry with them the additional risk of postoperative diplopia, besides leaving an external scar.

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