Lateral paracanthal transconjunctival incision for orbital fractures

Yoon, Eul Sik; Koo, Sang Whan; Park, Seung Ha; Ahn, Duck Sun

Abstract

Orbital fracture represents one of the common lesions encountered today with our modern mechanized life. Reduction of these fracture is important in preventing the untoward complications that may ensue such as diplopia and enopththalmos. Although various types of incision have been employed to approach the orbital floor and infraorbital rim, subcilliary and transconjunctival approach are most commonly used. The subcilliary approach has been used for a number of years successfully although it does have shortcommings such as cutaneous scar and ectropion in many cases. The conventional transconjunctival approach provides limited exposure, so it can be used only with small fractures. In order to avoid above problems, it is preferable to use a paracanthal transconjunctival incision: however, it is combined with severance of the lower limb of the lateral canthal tendon approximately 2mm from the canthus. We have used this technique in fifty one cases with diagnosis varying from blow-out fracture to extensive facial fracture. We found that this approach provides good exposure and gives an excellent postoperative result with a concealed apparent cutaneous scarring and no scleral or corneal complications and visualization of the orbital floor and rim with minimal morbidity and insignificant cosmetic impact. In contrast to previously reported similar approaches, it is simple to use in traumatic and congenital lesions that go beyond the orbital floor.