Lateral Orbital Rim Osteotomy

In some situations, the corridor created by the endoscopic transorbital approach (ETOA) may be too limited, which may restrict the surgical exposure, constrain the maneuverability of surgical instruments, and increase the risk of injury to the orbital contents during retraction and manipulation, particularly when multiple instruments are being used. To overcome these limitations, the lateral orbital bone can be temporarily removed by performing a lateral orbital rim (LOR) osteotomy. This can significantly enhance surgical exposure, increase instrument maneuverability and reduce the need to retract the orbital contents. Hence, the LOR osteotomy can be a useful adjunct in selected cases with deeper lesions or those requiring more extensive manipulation during ETOA. In this chapter, we describe the technical nuances of the LOR osteotomy in ETOA.