Table Of ContentEndoscopic Surgery of the Orbit
Endoscopic Surgery of the Orbit
Raj Sindwani, MD, FACS, FRCS(C)
Vice Chairman and SectionHead
Rhinology, Sinus & Skull Base Surgeryj Head and NeckInstitute
Co-Director jMinimally Invasive Cranial Base & Pituitary SurgeryProgram
Rosa Ella Burkhardt Brain Tumor &Neuro-Oncology Center
Vice Chair of Enterprise Surgical OperationsjCleveland Clinic
Cleveland, Ohio
Elsevier
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ENDOSCOPICSURGERYOFTHEORBIT ISBN:978-0-323-61329-3
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This book is dedicated to my daughters, Sienna and Sasha,
whose mere presence makes me want to be a better person and make our world a better place.
Girls, always remember that your place in the world is wherever and whatever you want it to be.
The fact that this book now exists in physical form is a testament to the love,
support, and countless sacrifices of several people in my life—most notably my parents and my wife,
Sangeeta—who, first, convinced me that I really could do anything that I put my mind to,
and then, second, provided me the runway to do it.
Raj Sindwani, MD, FACS, FRCS(C)
Preface
This textbook is as unique as the evolving field of endoscopic otolaryngology and ophthalmology. Beyond even this core dyad,
orbital surgery. More than any other sphere, contemporary however, the complex nature of endoscopic orbital surgery
approachestotheorbitandskullbasearetheepitomeofmultidis- requires a cohesive, multidisciplinary team consisting of otolar-
ciplinary care and the “team of teams” approach to problem- yngologists, ophthalmologists, neurosurgeons, endocrinologists,
solving.Theseapproachestakeexquisiteadvantageoftheanatomic medical and radiation oncologists, and radiologists and patholo-
realitythatthesinonasaltractislargelyanair-filledcolumnofbony gists. In addition to providing expertise and perspectives from
cells that can readily be removed without consequence. At their thesevariousspecialties,EndoscopicSurgeryoftheOrbit(1stedition)
core,theadvantagesofendoscopicapproachestotheorbitclosely also highlights the two-surgeon, multihanded surgical techniques
paralleltheadvantagesthatwenowroutinelyleverageduringendo- that have ushered in a new era in managing complex pathologies
scopicskullbasetechniques—namely,direct-lineaccesstopathol- involvingtheorbitandskullbase.
ogyinhard-to-reachareasoftheheadthatweareabletomanage Infused with the knowledge and wisdom of global thought
throughthenosewithminimalretractiononsensitiveneurovascu- leaders,itwasmymissiontoprovideacomprehensiveresourcethat
lar structures. could serve as an authoritative text to practitioners performing
With concurrent improvement in office examination tech- endoscopic orbital procedures and caring for these patients. I am
niquesandimagingtechnology,clinicianswithaninterestindisor- immensely grateful to my distinguished colleagues and friends
dersaffectingtheorbitareoftenabletoachieveincreasedprecision for their contributions to this important project; your time and
inpreoperativediagnosisandoffertheirpatientsmorerefined,and dedication are very much appreciated.
insomecaseslessinvasive,treatmentoptions.Minimallyinvasive It is my sincere hope that readers find this work informative,
orbitaltechniquesofferthepromiseofamorestreamlinedapproach thought-provoking, entertaining, and inspiring.
to comprehensive patient care, improved patient satisfaction and
Raj Sindwani,MD, FACS, FRCS(C)
experience,andsuperioroutcomes.
The modern era of endoscopic surgery of the orbit has wit-
nessed an unparalleled partnership between the specialties of
vi
Biography
Raj Sindwani, MD, FACS, EnterpriseSurgicalOperations.Inthisrole,heandhisteamcham-
FRCS(C) pion procedural and surgical safety and quality while working to
Dr. Sindwani is vice chair- address access, efficiency, and service-line development across
man and head of the Section the Cleveland Clinic health system. He also serves as president-
of Rhinology, Sinus & Skull electofthemedicalstaffandisamemberoftheClevelandClinic
Base Surgery of the Head & Boardof Governors.
NeckInstituteattheCleveland Dr. Sindwani is presently the editor-in-chief of the American
Clinic.Heisalsoco-directorof JournalofRhinology&Allergyandpasteditor-in-chiefoftheYear
the Minimally Invasive Cranial Book ofOtolaryngology.Heservesonseveralhigh-impacteditorial
Base and Pituitary Program of andscientificadvisoryboardsandhastrainedmanyfellowsandres-
the Rose Ella Burkhardt Brain idents.Heisanestablishedauthorityonthemedicalandsurgical
Tumor and Neuro-Oncology management of conditions affecting the sinuses, orbit, and skull
Center. He has held several base and has pioneered endoscopic surgical approaches to these
important leadership roles at regions.Hehaspublishedextensivelyinthefieldandhaslectured
the Cleveland Clinic and is atmanyinstitutions,instructionalcourses,andscientificsymposia
currently vice chairman of aroundtheworld.
vii
Video Contents
13-1 EndoscopicDacryocystorhinostomy 33-1 Endoscopic Repair ofaMedialOrbitalWall Facture
JessicaW.Grayson With the“Milan Technique”
MarcoMolteni
21-1 OpticNerve Decompression
NicoleI.Farber 33-2 Endoscopic Medial Orbital WallReconstruction After
29-1 Endoscopic-Assisted OrbitalExenteration RemovalofanOrbitalMassViaaTransnasalApproach
DonaldCharlesLanza MarcoMolteni
30-1 RightOrbital Subperiosteal AbscessDrainage
RonMitchell
xv
Contributors
Omar H.Ahmed, MD Benjamin S. Bleier, MD
Fellow,Rhinology and Cranial Base Surgery Associate Professor
Departmentof Otolaryngology Directorof EndoscopicSkull Base Surgery
University of Pittsburgh Medical Center Co-Director Center forThyroid Eye
Pittsburgh, PA, United States Disease and Orbital Surgery
Department of Otolaryngology – Head and NeckSurgery
Massachusetts Eye and Ear Infirmary
Shaheryar F.Ansari,MD Harvard Medical School
Fellow,PacificNeuroscience Institute Boston, MA, United States
John Wayne Cancer Institute
Providence’sSaint John’sHealth Center
Santa Monica, CA, United States Kofi Boahene,MD
Professor
Department of Otolaryngology – Head and Neck Surgery
Leopold Arko IV, MD JohnsHopkins
Minimally Invasive EndoscopicSkull Baltimore, MD, United States
BaseFellow
Departmentof Neurological Surgery
HamidBorghei-Ravazi,MD
Weill Cornell MedicalCollege
New York PresbyterianHospital Assistant Professor
New York,NY,United States Department of Neurosurgery
Cleveland Clinic Florida
Weston, FL,United States
Catherine Banks, MD, FRACS
Fellow/ClinicalInstructor inRhinology andSkull
ZacharyJ.Cappello, MD
BaseSurgery
Otolaryngologist
Departmentof Otolaryngology
Charlotte Eye, Ear, Nose,and Throat Associates
Massachusetts Eye and Ear Infirmary
Charlotte, NC, United States
Harvard MedicalSchool
Boston, MA, United States
Anais L.Carniciu, MD
Department of Ophthalmology
GarniBarkhoudarian, MD,PhD
University Hospitals Cleveland MedicalCenter
Associate Professor
Case Western Reserve University School of Medicine
Departmentof Neuroscience and Neurosurgery
Cleveland, OH, United States
John Wayne Cancer Institute
Santa Monica, CA, United States
Ricardo L.Carrau, MD
Professor
Federico Biglioli, MD
Departments of Otolaryngology –Head and
Professor and Chair
Neck Surgery
MaxillofacialSurgery Unit
Neurological Surgery, and Communication Sciences
Santi PaoloeCarlo Hospital, Università degli
and Disorders
Studi diMilano
The Ohio StateUniversity
Milan, Italy
Columbus, OH, United States
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