187 / 236
Endoscopic OCH resection
TABLE 3.
Intraoperative characteristics
n
%
Team
ENT
23
100.0
Ophthalmology
6
26.1
Neurosurgery
5
21.7
Use of image guidance
Yes
19
82.6
No
4
17.4
Approach
Single nostril
16
69.6
Middle turbinectomy
8
34.8
Binarial
6
26.1
Septal window
4
17.4
Middle turbinate swing
a
1
4.3
Number of hands/surgeons
2/1
7
30.4
3/2
10
43.5
4/2
6
26.1
Medial rectus retraction
None
12
52.2
Double ball probe retraction
3
13.0
Transseptal suture retraction
b
2
8.7
Blunt dissection
2
8.7
Medial rectus detached
1
4.3
Hemostasis
Bipolar
13
56.5
None
6
26.1
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
)
TABLE 3.
Continued
n
%
None
17
73.9
Mucosal graft
5
21.7
Fascia lata
1
4.3
Packing
None
12
52.2
Nonabsorbable
10
43.5
Absorbable
1
4.3
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
n
%
Eye position
No change/symmetric
18
78.3
Enophthalmos
5
21.7
Proptosis
0
0.0
Diplopia
None
14
60.9
Worse
6
26.1
Better
3
13.0
Vision
Improved
12
52.2
No change
11
47.8
Worse
0
0.0
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%
International Forum of Allergy & Rhinology, Vol. 6, No. 2, February 2016
165