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J Neurol Surg B Skull Base
DOI: 10.1055/a-2565-9056
Original Article

Endoscopic Transnasal Approach for Deep Lateral Orbital Decompression: A Cadaver Study

Teppei Takeda 
1   Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
2   Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, United States
,
Yasine Mirmozaffari
2   Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, United States
,
Asha Nadabar
2   Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, United States
,
Jackson R. Vuncannon
2   Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, United States
,
Jared Martin
2   Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, United States
,
Adam J. Kimple
2   Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, United States
,
Brent A. Senior
2   Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, United States
,
Kazuhiro Omura 
1   Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
,
Nobuyoshi Otori
1   Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
,
Charles Ebert
2   Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, United States
,
Christine Klatt-Cromwell
2   Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, United States
,
Brian D. Thorp
2   Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, United States
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Abstract

Objectives

This study evaluates the anatomical feasibility of an endoscopic transnasal approach for deep lateral orbital decompression using cadaver models.

Design

Cadaver study.

Participants

Four fresh frozen cadaver heads (eight sides) were used.

Main Outcome Measures

Measurements of the sphenoid trigone before and after bone removal were assessed using CT scans. Key outcome measures included the width, height, depth, and volume of the trigone.

Results

The transnasal approach achieved a 53.9% reduction in trigone volume, with significant decreases in height (65.0%), width (84.3%), and depth (76.8%). Preoperative measurements revealed an average orbital surface width of 20.0 mm, later reduced to 16.7 mm postoperatively. The average trigone depth was reduced from 16.1 to 12.0 mm, and height decreased from 21.3 to 13.4 mm in the postoperative assessment. The procedure showed a mild limitation in reduction along the cephalocaudal axis, with residual regions measuring 4.5 and 3.0 mm in the superior and inferior directions, respectively.

Conclusion

The endoscopic transnasal approach effectively reduces the size of the sphenoid trigone, providing a promising alternative for orbital decompression with potential clinical applications. Future research should explore long-term outcomes and integration into surgical practice.

Keywords

orbital decompression - endoscopic transnasal approach - sphenoid trigone - cadaver study - orbital surgery - exophthalmos

Author Contributions

Conceptualization of the study, data analysis, and writing of the original draft: TT. Data collection: YM, AN, JRV, and JM. Manuscript editing: AJK, BSA, KO, NO, CE, and CKC. Final review and editing of the manuscript: BDT.




Publication History

Received: 25 February 2025

Accepted: 21 March 2025

Accepted Manuscript online:
25 March 2025

Article published online:
21 April 2025

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