67445 Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of bone for decompression

Name of the Procedure:

Orbitotomy with bone flap or window, lateral approach (e.g., Kroenlein); with removal of bone for decompression.

Summary

This surgical procedure involves making an incision and creating a window in the bone of the orbit (eye socket) through a lateral approach. The bone flap is temporarily removed, allowing the surgeon to access and decompress the contents of the orbit to alleviate pressure.

Purpose

The procedure is primarily done to relieve pressure within the eye socket caused by conditions such as tumors, trauma, or inflammation. The goal is to reduce symptoms like pain, vision impairment, and other complications related to increased orbital pressure.

Indications

• Tumors or masses in the orbital area.
• Traumatic injuries resulting in orbital fractures or increased pressure.
• Severe inflammation or infection within the orbit.
• Thyroid eye disease causing significant orbital congestion and pressure.

Preparation

• Fasting for at least 6-8 hours before surgery.
• Adjusting or discontinuing certain medications as advised by the healthcare provider.
• Comprehensive eye examination and imaging studies such as CT scans or MRIs to plan the surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made on the lateral (side) part of the orbit.
3. A bone flap or window is carefully created in the orbital bone.
4. The bone section is temporarily removed to provide access to the orbital contents.
5. The surgeon decompresses the orbit by removing or relieving any mass, fluid, or tissue causing pressure.
6. The bone flap is either replaced or modified as needed and secured.
7. The incision is closed with sutures.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity of the case.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• An ophthalmic or maxillofacial surgeon.
• Anesthesiologist.
• Surgical nurses.
• Surgical technologists.

Risks and Complications

• Infection.
• Bleeding or hematoma.
• Damage to surrounding structures, including muscles and nerves affecting eye movement and vision.
• Persistent pain or discomfort.
• Scarring or cosmetic changes.

Benefits

• Relief from orbital pressure and associated symptoms.
• Improved vision and eye function.
• Reduced pain and discomfort.
• Prevention of further complications related to untreated orbital pressure.

Recovery

• Post-procedure, patients may need to stay in the hospital for observation.
• Pain management with prescribed medications.
• Instructions to keep the head elevated and avoid strenuous activities.
• Follow-up appointments for monitoring recovery and managing any complications.
• Most patients can expect to return to normal activities within a few weeks to a few months.

Alternatives

• Medical management with medications for inflammatory conditions.
• Minimally invasive procedures for specific conditions.
• Radiation therapy for some types of orbital tumors.

Pros and cons of alternatives depend on the condition being treated; some alternatives may be less invasive but less effective for severe cases.

Patient Experience

Patients will experience general anesthesia during the procedure, ensuring no pain or awareness. Post-surgery, they may feel pain, swelling, and discomfort, managed with medications. Most activities can be resumed after a few weeks, with a gradual return to normal. Regular follow-up is essential to ensure proper healing and outcome assessment.