Transmaxillary Approach to the Orbit: An Anatomic Study

OBJECTIVE Various approaches to expose the orbit have been used, such as cranial, lateral, and medial approaches. In an effort to gain exposure to the orbit without necessitating a craniotomy, we have developed a transmaxillary approach to the orbit. METHODS An approach was developed that uses data obtained by performing 24 orbit dissections in 12 cadaveric heads. After sublabial incision to expose the maxilla, maxillotomy is performed and the course of the infraorbital nerve is identified. The orbital floor is opened, and the orbit is accessed. RESULTS This technique offers access to the inferomedial and inferolateral orbit and to the inferior aspect of the optic nerve. CONCLUSION The transmaxillary approach provides an entirely extradural approach to the orbit. This technique combines the benefits of a cosmetically acceptable approach with orbitotomy and avoids the use of craniotomy and brain retraction to access the deep medial, lateral, and inferior orbit. We advocate the transmaxillary approach to the orbit in cases of inferomedial posterior intraconal and inferolateral lesions as an alternative and adjunct to the standard techniques of orbital surgery.