Revival of the lateral bone flap orbitotomy without disinsertion of the temporalis muscle in the era of piezoelectric surgical devices

PURPOSE: To introduce a modification of the lateral bone flap orbitotomy that allows the osteotomy to be performed with a piezoelectric cutting device without the disinsertion of the temporalis muscle, with review of experience with six cases. METHODS: Description of surgical technique and a case series of six patients undergoing this modified technique. RESULTS: Six patients with orbital lesions, including three cavernous malformations, one pleomorphic adenoma, one hybrid neurofibroma-schwannoma, and one sphenoid wing meningioma, underwent successful lesion resection by a single surgeon via an attached lateral bone flap orbitotomy with vascularized temporalis muscle pedicle approach. There were no cases of vision loss, long-standing anisocoria, permanent numbness, or complaints of temporalis hollowing. One patient experienced progression of the pre-existing abduction deficit. CONCLUSIONS: Lateral bone flap orbitotomy using piezoelectric osteotomy without disinsertion of the temporalis muscle provides excellent surgical exposure and, at least conceptually, reduces risks associated with traditional bone flap orbitotomy with disinsertion of the temporalis muscle.