Endoscopic Surgery of the Orbit: Anatomy, Pathology, and Management

Review by L Flood
Middlesborough, UK

It is a curious UK convention that the contents of the orbit, other than the globe itself, are largely the province of our specialty and not within the remit of many ophthalmic surgeons. Most of us in ENT, however, regard anything beyond the periosteum as a territory to be avoided if at all possible. Whether with a scalpel or an endoscope, we will happily drain the abscess characteristic of the third stage of Chandler’s classification of orbital cellulitis, or perform a lateral canthotomy in an emergency (Fig. 18.6 is rather striking on this subject!). Orbital fat we usually want nothing to do with, especially when seen endoscopically.

But endoscopic surgery of the orbit? The very concept shows how far rhinology has advanced since the days when we struggled with the dim illumination of an electric headlamp. Indeed, one of the chapters is entitled ‘Transorbital Approaches to the Sinuses etc.’. Hang on, I thought. Surely that is the reverse of all our traditional thinking!

The multi-author contribution is largely US- and Australian- based. A healthy proportion of the authors are otolaryngologists, and our own Prof Valerie Lund offers a Foreword and a chapter on iatrogenic injury of the orbit. Frankly, even if one never wielded an endoscope, this is an excellent review of a territory still a mystery to many. Coverage starts with the basic sciences and radiology. Subsequent chapters do remind one just how much ENT surgery has actually always interacted with the orbit, whether in nasolacrimal duct obstruction, orbital decompression for exophthalmos, sepsis secondary to sinusitis, or trauma repair. Orbital tumours and transorbital approaches to the skull base will surely remain in the hands of only the most advanced experts.

As is to be expected from this publisher, the profuse illustrations, whether of imaging, colour endoscopic photographs or anatomy diagrams, are superbly reproduced. Additional media include online access to the e-book and to surgical videos, via MedOne.

This field is variously described as ‘a new frontier’ or ‘one of the most rapidly advancing areas in modern day rhinology and ophthalmic plastic surgery’, and it was particularly clever to produce a book of such novelty. The book is highly recommended to anyone venturing near the orbit, endoscopically or not. It will particularly appeal to those rhinologists looking for new challenges and skills.

Amazon Link: Endoscopic Surgery of the Orbit: Anatomy, Pathology, and Management
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