Anatomy of Deep Lateral and Medial Orbital Walls: Implications in Orbital Decompression Surgery

Abstract Background: Isolated deep lateral and combined medial orbital wall decompressions (balanced decompression) are well accepted for treatment of disfiguring proptosis and compressive optic neuropathy in patients with Graves’ orbitopathy. However, cerebrospinal fluid leakage and/or optic nerve injury occasionally occur during these operations. Purpose: To describe the anatomy of the deep lateral and medial orbital walls and its surgical implications in orbital decompression. Methods: We reviewed literature on the anatomy of the deep lateral and medical orbital walls. In addition, we performed cadaver dissection and computed tomographics studies to illustrate the anatomy. Results: We provided an anatomical overview and elucidated the detailed surgical anatomy of the posterior and superior borders of the deep lateral orbital wall, the posterior and accessory ethmoidal foramina, and the frontoethmoidal suture. Conclusions: The anatomy of the deep lateral and medical orbital walls presented here will warrant safe and confident performance of orbital decompression surgery.