SUPEROLATERAL APPROACH TO ORBITAL TUMORS

The conventional lateral approach to the orbit (Kronlein) does not all ow a satisfactory view of the superior part of the orbit and the opera tive field is rather narrow. Therefore, large tumors which have develo ped not only laterally but also superiorly are usually approached tran scranially. The craniotomy and exposure of the dura may be avoided whe n the tumor does not extend too far posteriorly and medially, by turni ng a larger orbital bone flap than the Kronlein's one. This technique was described by Nakamura as ''type I orbitotomy'' and can be referred to as a superolateral approach. After a bicoronal skin incision, a fr ee orbital bone flap is cut. It includes the lateral orbital rim, a la rge external part of the superior orbital rim, and the lateral orbital wall. From 1985 to 1990 this approach was performed on 23 patients pr esenting with lacrimal gland tumors in 14 cases (11 pleomorphic adenom as, 2 adenoid cystic carcinomas, 1 adenocarcinoma), schwannomas in 2 c ases, dermoid cyst in 1 case, hydatic cyst in 1 case, cavernous hemang iomas in 2 cases, inflammatory pseudotumor in 1 case, and mucoceles in 2 cases. This superolateral approach provides a wider exposure to the superolateral orbit than the classical Kronlein's approach and avoids the drawbacks of a craniotomy. A direct incision through the eyebrow can be used for bald people or for patients in poor condition.