Cadaveric Anatomical Study of Orbit-Preserving Ophthalmic Neurectomy via Endoscopic and Exoscopic Techniques.

Abstract

Background: Perineural spread of cutaneous head and neck squamous cell carcinoma is most effectively managed by surgical resection with a clear central margin at the affected nerve. For ophthalmic nerve disease, there is no clear consensus regarding the extent of spread which is resectable via an orbit-preserving neurectomy, either in regard to oncological outcome or technical feasibility.

Methods: Cadaveric anatomical study of 10 human orbits, with endoscopic and exoscopic dissection of the frontal division of the ophthalmic nerve, to quantify the maximal extent of resection via orbit-preserving techniques and to discern the advantages and disadvantages of exoscopic versus endoscopic visualization aids.

Results: Mean achievable resection length measured from the supraorbital ridge was 40.9 mm (n = 10). No branching patterns were identified which would preclude neurectomy as an oncologically sound option.

Conclusions: Orbit-preserving resection of the ophthalmic nerve is technically feasible to a distance of approximately 4 cm, encompassing the majority of Williams Zone 1.