Clinical and anatomical choosing access to the frontal sinus and the superior wall of the orbit

Background. The frontal sinus and orbital superior wall are complex anatomical regions, and the classic approach is a bicoronal approach. The transorbital approach has historically been used only for limited pathological processes in the anterior superior orbit. Objective. The aim of the study was the anatomical and clinical justification of the differentiated use of bicoronary and transciliary approaches in pathological processes of the fronto-orbital localization. Material and methods. This experimental study was performed using frozen native human head specimens, which were used to model and measure the anatomical and surgical parameters of the bicoronary and transciliary transorbital approaches. Using the obtained data, the choice of surgical approach was justified in two patients with fronto-orbital tumors. Results. No significant differences were found between the bicoronal and transciliary approaches in terms of surgical wound depth, attack angles, and orbital access area. Conclusion. Indications for the transciliary transorbital approach include pathological processes in the superior and superomedial orbit, including the adjacent lateral portions of the ipsilateral frontal sinus. The bicoronal approach is justified when wide exposure of the squama of the frontal bone and extensive trepanation of the anterior wall of the frontal sinus are necessary.