The Revised Direct Transconjunctival Approach to the Orbital Floor

Ophthalmic Plastic and Reconstructive Surgery
Francesco P BernardiniAntonio Augusto V Cruz

Abstract

To review common surgical approaches to the orbital floor and to evaluate the utility of canthal-sparing, single incision transconjunctival method. A retrospective chart review of a consecutive series of patients who underwent transconjunctival, direct incision surgery without eyelid dissection or lateral canthotomy and inferior cantholysis and review of the literature were conducted. Twenty-three consecutive patients (33 orbits) were operated using a canthal-sparing direct single cut approach, including 10 unilateral pediatric orbital floor fractures, 1 orbital floor implant removal, 2 unilateral post-traumatic enophthalmos repairs, and 10 bilateral orbital floor decompressions. Surgical exposure was adequate to complete the surgical objective in each patient. Mean follow up was 13 months and no complications were observed. The transconjunctival approach to the orbital floor can be performed using a pre- or post-septal dissection, with infratarsal or fornix incision commonly associated with lateral canthotomy and inferior cantholysis. The direct approach spares the lateral canthus, minimizes lower eyelid dissection, and provides rapid and effective access to the inferior orbital rim and orbital floor. It offers sufficient expo...Continue Reading

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