Abstract
Objectives The one-piece supraorbital approach is a rational approach for the removal of orbital
tumors. However, cutting the roof through the orbit is often difficult. We modified
the technique to facilitate the osteotomy and improve the cosmetic effect.
Design Three burr holes are made: the first, the MacCarty keyhole (burr hole 1), exposes
the anterior cranial fossa and orbit; the second is placed above the supraorbital
nerve (burr hole 2); and the third on the superior temporal line. Through burr hole
2, a small hole is created on the roof, 10 mm in depth. Next the roof is rongeured
through burr hole 1 toward the preexisting small hole. Seamless osteotomies using
a diamond-coated threadwire saw and the preexisting four holes are performed. Lastly
the flap is removed. On closure, sutures are passed through holes in the cuts made
with the threadwire saw, and tied.
Results We applied our technique to address orbital tumors in two adult patients. The osteotomies
in the roof were easy, and most parts of the roof were repositioned.
Conclusions Our modification results in orbital osteotomies with greater preservation of the
roof. Because the self-fitting flap does not require the use of fixation devices,
the reconstruction is cosmetically satisfactory.
Keywords
orbital roof - orbital tumor - osteotomy - supraorbital approach - threadwire saw
