Combined Transconjunctival and Transcaruncular Approach for Repair of Large Orbital Floor and Medial Wall Fracture: A Case Report
Abstract
A variety of approaches have been documented in literature for accessing the orbital floor and medial wall fractures. Several transcutaneous approaches were used traditionally, to access these regions. However, significant postoperative complications associated with these approaches have been reported. The transconjunctival approach was introduced to overcome these complications. However, the medial wall of the orbit was found to be difficult to gain access to, due to the vital structures in this area. The Lynch incision was the conventional approach of choice for access to the medial wall of the orbit. However, since 1998 the transcaruncular approach kept gaining popularity. The combined transconjunctival and transcaruncular approach to gain access to these fractures has recently been re-evaluated. We present a case of a patient with orbital floor and medial wall fractures secondary to trauma where a combined transconjunctival and transcaruncular incision was used.
Downloads
References
Markiewicz MR, Bell RB. Traditional and contemporary surgical approaches to the orbit. Oral Maxillofac Surg Clin North Am. 2012 Nov;24(4):573-607.
Boyette JR, Pemberton JD, Bonilla-Velez J. Management of orbital fractures: challenges and solutions [Internet]. Vol. 9, Clinical Ophthalmology. Dove Press; 2015 p. 2127–37.
Harish KM, Bhagat JA, Tulasidas G. A Case Report of Scarless Direct Access to the Infraorbital Rim Using a Retroseptal Transconjuctival Approach. Cureus. 11(1):e3836.
Garcia GH, Goldberg RA, Shorr N. The transcaruncular approach in repair of orbital fractures: a retrospective study. J Cranio-Maxillofac Trauma. 1998;4(1):7–12.
Nguyen DC, Shahzad F, Snyder-Warwick A, Patel KB, Woo AS. Transcaruncular Approach for Treatment of Medial Wall and Large Orbital Blowout Fractures. Craniomaxillofacial Trauma Reconstr. 2016 Mar;9(1):46–54.
Werther JR. Cutaneous approaches to the lower lid and orbit. J Oral Maxillofac Surg. 1998 Jan;56(1):60-5.
Patel PC, Sobota BT, Patel NM, Greene JS, Millman B. Comparison of transconjunctival versus subciliary approaches for orbital fractures: a review of 60 cases. J Cranio-Maxillofac Trauma. 1998;4(1):17–21.
Appling WD, Patrinely JR, Salzer TA. Transconjunctival approach vs subciliary skin-muscle flap approach for orbital fracture repair. Arch Otolaryngol Head Neck Surg. 1993 Sep;119(9):1000–7.
Rohrich RJ, Janis JE, Adams WP. Subciliary versus subtarsal approaches to orbitozygomatic fractures. Plast Reconstr Surg. 2003 Apr 15;111(5):1708–14.
Rootman J. Orbital Surgery: A Conceptual Approach. Wolters Kluwer/Lippincott Williams & Wilkins; 2013. 419 p.
