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

Abstract

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