Clinical Experience of the Modified Transconjunctival Lower Lid Approach for
Orbital Fractures with Lateral Peri-canthal Incision
Eui Cheol Jeong M.D., 1Jeonghoon Song M.D., 2Gordon K. Lee M.D., Ji Ung Park
M.D., Suk Wha Kim M.D., Sung Tack Kwon M.D.
Department of Plastic surgery, SMG-SNU Boramae Medical Center and
Department of Plastic and Reconstructive surgery, College of Medicine, Seoul
National University, Seoul, Korea
1Department
of Plastic and Reconstructive surgery, College of Medicine,
Wonkwang University, Iksan, Korea
2Division
of Plastic and Reconstructive surgery, Stanford University Medical Center,
Stanford, CA, USA
Abstract
Purpose
Optimal repair of orbital fractures requires adequate exposure of the fracture area. The
transconjunctival approach with lateral canthotomy has gained increasing popularity. This
technique offers arguably improved visualization with lower risk of lid retraction. However,
if the lateral canthotomy area is improperly repaired, it may cause lower lid malposition
and deformity.1The authors report the use of a modified transconjunctival incision
method with a lateral peri-canthal incision to overcome this problem in the cantholysis.
Method and Materials
Between January 2011 and December 2012, the authors used this technique in 30
patients with orbital fractures. When the transconjunctival approach was performed, an
inferolateral incision of the lower eyelid near the lateral canthus including the tarsal plate
was added instead of the common lateral canthotomy incision for the cantholysis (see
Figure 1).
Result
Average follow-up was 6 months. There were no functional complications (no webbing,
no ectropion, no entropion, etc) related to the operation. In 28 of 30 cases (93%) they
were rated as having an excellent cosmetic outcome; however, there were two cases (7%)
with complications. One patient had a subcutaneous preseptal hematoma, which required
reoperation to obtain hemostasis. In another patient, there was a notch deformity on the
lower eyelid margin, but the patient was satisfied and did not choose to have it revised.
Conclusions
The authors believe that for orbital fracture repair the modified transconjunctival incision
with lateral peri-canthal incision can be easily performed and reliably repaired as
opposed to the more traditional lateral canthotomy technique. We believe that there is
more anatomical reliability in repairing the tarsal plate rather than the attachment of the
lateral canthus. Furthermore, in our experience this modified technique provided more
than adequate exposure for fracture repair, with excellent cosmetic and functional result
on long-term follow-up.
Figure 1. Transconjunctival incision with lateral peri-canthal incision
Reference
1. Ridgway EB, Chen C, Lee BT. Acquired entropion associated with the transconjunctival
incision for facial fracture management. J Craniofac Surg. 2009 Sep;20(5):1412-5.
Disclosure
None of the authors has a financial interest in any of the products, devices, or drugs
mentioned in this manuscript