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Lateral Orbital Approach

Surgical Correlation

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E, The orbital fat has been removed to expose the optic nerve and insertion of the lateral rectus and inferior oblique muscles on the globe. The superior ophthalmic vein, the nasociliary nerve, and the lacrimal and ciliary arteries and nerves are exposed above the lateral rectus muscle. F, Combining the lateral orbital exposure with a frontotemporal craniotomy permits exposure of the superior orbital fissure, anterior cavernous sinus, and the frontal and temporal lobes adjoining the sylvian fissure. The lateral orbital wall has been removed to expose the periorbita. G, The combined craniotomy and lateral orbitotomy exposures include the anterior part of cavernous sinus, the superior orbital fissure, and the lateral orbit. The anterior clinoid process and a portion of the optic strut have been removed. The bone around the optic canal has been removed to expose the optic sheath. H, The periorbita has been opened to expose the lateral rectus muscle. The lacrimal and frontal nerves course through the lateral part of the superior orbital fissure. The superior ophthalmic vein courses along the lateral margin of the annular tendon. I, The lateral rectus muscle has been reflected posteriorly. The ciliary ganglion is located on the lateral side of the ophthalmic artery and optic nerves. The abducens nerve enters the medial side of the lateral rectus muscle. The motor root of the ciliary ganglion arises from the branch of the inferior oculomotor division to the inferior oblique muscle. The sensory root of the ciliary ganglion arises from the nasociliary. The ciliary ganglion gives rise to short ciliary nerves. (Images courtesy of AL Rhoton, Jr.)

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