Anatomy of Deep Lateral and Medial Orbital Walls: Implications in Orbital Decompression Surgery

Abstract

Background: Isolated deep lateral and combined medial orbital wall decompressions (balanced decompression) are well accepted for treatment of disfiguring proptosis and compressive optic neuropathy in patients with Graves’ orbitopathy. However, cerebrospinal fluid leakage and/or optic nerve injury occasionally occur during these operations.

Purpose: To describe the anatomy of the deep lateral and medial orbital walls and its surgical implications in orbital decompression.

Methods: We reviewed literature on the anatomy of the deep lateral and medical orbital walls. In addition, we performed cadaver dissection and computed tomographics studies to illustrate the anatomy.

Results: We provided an anatomical overview and elucidated the detailed surgical anatomy of the posterior and superior borders of the deep lateral orbital wall, the posterior and accessory ethmoidal foramina, and the frontoethmoidal suture.

Conclusions: The anatomy of the deep lateral and medical orbital walls presented here will warrant safe and confident performance of orbital decompression surgery.

• Anatomy
• cerebrospinal fluid leakage
• optic nerve injury
• orbital decompression
• orbital wall

Acknowledgements

All cadavers were Japanese and were registered with Aichi Medical University. Proper consent and approval were obtained prior to their use. The methods used to secure the tissues were humane and complied with the tenets of the Declaration of Helsinki.