Combined internal and external orbitotomy

Lateral opening is a standard surgical approach for treating post-balloon tumors. In 1888, Kronlein first proposed lateral open surgery for the removal of dermoid cysts, which had a "U" shape. In 1953, Berke and Reese improved the incision and transitioned to a horizontal incision of 30 to 35 mm. Later, the incision was called the Kronlein-Berke-Reese incision. Wright then modified the incision and turned the incision into the upper rim of the iliac crest without cutting the external malleolus to facilitate the resection of the epithelial tumor of the lacrimal gland. At present, due to the development of imaging, such as ultrasound, CT and MRI, the orbital tumor can make a more accurate positioning and qualitative diagnosis before surgery, and can realistically depict the location and shape of the tumor, thus deepening the doctor. Preoperative understanding of orbital tumors. Because the lateral opening can be combined with other procedures, it has become the most common type of opening surgery today. For example, the medial iliac crest is combined with the medial iliac crest to treat the tumor on the medial side of the iliac crest. Lateral sputum surgery is difficult to expose the lesions on the medial side of the optic nerve, especially in the tip of the sac. If the lateral opening surgery is to expose the lesion on the medial side of the optic nerve, it is necessary to pull the optic nerve to one side. Because the lesion is far from the surgical approach, it is unfavorable, and it is easy to cause serious complications such as vision loss. Therefore, the lateral combined medial opening surgery is more suitable for the removal of tumors on the medial or the optic nerve. This approach was first proposed by Smith and applied to the clinic. The medial side of the optic nerve is an area that is difficult to reach by lateral sacral surgery. After the external lateral approach is used to remove the iliac crest, the eyeball is pulled toward the armpit, which widens the medial field of the optic nerve and facilitates tumor resection. Treatment of diseases: optic nerve disease, orbital venous hemangioma Indication 1. The tumor inside the bulb is a wide range of lesions that affect the medial side of the optic nerve, such as varicose veins and venous hemangioma. 2. It is not suitable for the medial optic nerve tumor with simple medial opening. 3. The lesion on the medial side of the optic nerve. Surgical procedure 1. Incision: The external iliac crest is cut 2cm to the deep fascia, the external iliac crest is cut, and the distractor is placed. The outer edge of the iliac crest was exposed, and the periosteum was cut along the outer edge of the iliac crest by 5 mm to form a transverse "work" shape, and the periosteum was separated to expose the bone wall. 2. Incision of the bone wall: The outer wall of the ankle is cut horizontally with a chainsaw at the base of the sac and the top of the dome. The bone flap is clamped with a rongeur and fractured outward. To enlarge the surgical effect, a part of the posterior wall of the ankle can be bitten. Cut horizontally at the center of the periosteum and enter the second surgical space. 3. Incision of the medial conjunctiva: Because the field inside the eyeball is narrow, the medial conjunctiva is cut by 180° in the teardrop shape, which is conducive to enlarge the surgical field. The inner rectus muscle was exposed and separated, and the inner rectus muscle 3-0 silk preset was cut, and the muscle was cut from the rectus adhesion point and the ligament was stopped. The inner rectus muscle is pulled inward, and the eyeball is pulled toward the inferior fossa. At this time, the inner side of the optic nerve is wide, and the eyeball can be pulled outward by 25 to 30 degrees. Separate into the muscle cone along the eyeball, and perform surgical resection of the medial and temporal tumors. 4. Delivery of tumor: According to the location of the tumor and the degree of adhesion, the tumor is delivered after separation. If there is tumor invasion on the outside of the optic nerve, it can be entered from the lateral field of the lateral approach and the tumor after the ball is removed; then the medial lesion is treated from the medial field. 5. Stitching: After the tumor is delivered, the hemostasis is fully stopped, and the severed rectus muscle is re-stitched. The bulbar conjunctiva was sutured continuously with a 5-0 black silk thread. The lateral contraction of the lateral iliac crest is opened, the periosteum is sutured, and the bone flap is restored. Suture the skin, skin and cleft palate, the incision is placed in the drainage tube, and the pressure bandage is applied. complication 1. The surgical technique has a great damage to the tissue inside the iliac crest, so the postoperative reaction is also heavier. 2. During the operation, the eyeball should not be placed too far outward to prevent vision damage due to eyeball blood supply disorders. 3. Other precautions are the same as lateral open surgery.