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New research · Ophthalmology
Ophthalmic plastic and reconstructive surgery · 4d
StudyOphthalmic plastic and reconstructive surgery · 2026

Impact of Orbital Rim Osteotomy on Surgical Freedom in Transorbital Endoscopic Approaches: A Cadaveric Study and Novel Methodology.

Lewis R Hains, Abhiram Hiwase, Justin Henkel … Dinesh Selva
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OphthalmologyStudy

Adding a superolateral orbital osteotomy greatly increased surgical exposure area during endoscopic skull-base surgery.

Impact of Orbital Rim Osteotomy on Surgical Freedom in Transorbital Endoscopic Approaches: A Cadaveric Study and Novel Methodology.

Lewis R Hains … Dinesh Selva
Ophthalmic plastic and reconstructive surgery · 2026
Purpose

Transorbital neuroendoscopic surgery (transorbital neuroendoscopic surgery) is an emerging minimally invasive skull-base approach.

Methods

Six fresh-frozen cadaveric specimens (11 orbits) underwent bilateral superior eyelid crease incisions and periorbital dissection to the meningo-orbital band and superior orbital fissure.

n = 11 orbits
Results

surgical working area nearly doubled versus the standard approach without the osteotomy

41.6cm2
TONES
70.38cm2
L-TONES
93.78cm2
SL-TONES
More results

Both approaches demonstrated statistically significant increases in surgical exposure area when calculated using both convex-hull and simple elliptical area (p < 0.001).

L-TONES provided 70.38 cm2 of exposure when using the convex hull.

“
Conclusion

This study presents a novel, inexpensive method of quantifying surgical exposure and demonstrates increased instrument freedom through the successive addition of lateral and superior orbitotomies during transorbital neuroendoscopic surgery dissection.

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