C. Ogura described the transantral approach in 1957. The inferior and medial walls of the orbit are removed via the maxillary sinus. This affords good anterior decompression and relief of proptosis. D. Decompression is also possible via an external ethmoidectomy approach. The medial orbital wall and floor medial to the infraorbital nerve are removed.
Periosteum is incised mainly posteriorly.
Preoperatively a careful history is important, especially if endoscopic surgery is planned. Aspirin use needs to be stopped prior to surgery. If epinephrine use is contraindicated, alternative approaches may be necessary. The CT of the sinuses should be evaluated closely for the course of the optic nerve and its relationship to the posterior ethmoid and the sphenoid sinuses. The size and shape of these sinuses are variable.