Transorbital Endoscopic Approach for Managing Challenging Frontal Sinus Lesions: Results and Operative Technique Description.

Objective: The aim of this study was to describe our experience using the transorbital endoscopic approach (TEA) in the frontal sinus and the step-by-step technique used. Materials and Methods: We reviewed the charts from adult patients who underwent management of frontal sinus lesions with TEA performed from 2017 to 2022. Results: Seven patients underwent eight surgeries for frontal sinus lesions using TEA in combination with the endoscopic transnasal approach (ETA), with the majority on the left side (5/8, 62.5%). The average age was 53.9 years, with six male patients and one female patient. Gross total resection (GTR) was achieved in all cases. The most common symptoms leading to surgery were headaches or a sensation of pressure in the forehead (5/8, 62.5%), followed by a decreased sense of smell (3/8, 37.5%), diplopia (3/8, 37.5%), proptosis (2/8, 20%), periorbital cellulitis (2/8, 20%), and decreased visual acuity (1/8, 12.5%). The most common etiology in this case series was mucocele (5/8, 62.5%), followed by osteoid osteoma (2/8, 20%), and inverted papilloma (1/8, 12.5%). The length of stay in all cases was 1 day. The most common complication was mild and transitory V1 numbness, which fully recovered after 6 months (5/8, 62.5%). The average follow-up period was 24.6 months (range of 3-48 months). Conclusion: Transoral Endoscopic Approach (TEA) demonstrated being a valuable complement to ETA approaches for treating frontal sinus lesions, especially in challenging regions. The transorbital approach is feasible and can safely achieve GTR for a variety of pathologies while effectively controlling symptoms and resulting in a 1-day hospital stay.