Repair of Medial Orbital Wall Fracture: Transcaruncular Approach

Abstract

The aim of this paper is to demonstrate the safety and the use of the transcaruncular approach as a surgical technique for managing a medial wall fracture. This approach was used in 40 patients with a isolated medial or a combined medial and inferior orbital wall fracture between September 1998 and September 2002. A computed tomographic scan was taken before and after surgery. The ocular motility and enophthalmos were checked before and after surgery. The transcaruncular approach provided the appropriate surgical exposure in all cases. Patients were followed up for a mean of 9.4 months (range, 524 months) after repairing the orbital wall fracture. Hertel exophthalmometry showed that among the 40 patients; 24 patients showed no enophthalmos. The enophthalmos ranged from 0.51 mm in 14 patients and 1.5 mm enphthalmos was noted in 2 patients. A clinically significant enophthalmos =2 mm was not found postoperatively. Preoperatively, 12 patients (30%) had a diplopia in the primary position of the gaze and 26 patients (65%) had a diplopia within 30 degrees of the gaze. Postoperatively, all patients had an orthotropia in the primary position but 4 patients (10%) had a residual diplopia either on the lateral gaze (2 patients) or the upgaze (2 patients). There were 2 cases of an implant misplacement. The transcaruncular approach provides a safe, rapid, and cosmetically pleasing surgical approach for managing a isolated medial wall fracture. When combined with the inferior transconjunctival approach, a combined medial and inferior orbital wall fracture can be successfully repaired.

Orbital fractures: a review

“…The Lynch incision provides excellent exposure, but it can result in severe scarring or webbing of the medial canthal skin. More recently, the transcaruncular approach has become a major approach to the medial orbit, as it avoids leaving a visible scar 17,18. As with floor fractures, most repairs involve returning the prolapsed soft tissue into the orbit, reconstructing the broken fragments, and then possibly reinforcing the medial wall with similar numerous implant materials, as mentioned previously.…”

Comparison of the Postoperative Outcome in Pure Medial Orbital Fracture Among Three Groups

“…1,2,7 Medial canthal incision and transcaruncular incision require the use of alloplastic implant materials. 1,2,8 Antral approach has a limited approach to the medial orbital wall. 12 Transnasal endoscopic approach requires the use of expensive equipment, additional education for the surgeon to become fully skilled to manipulate the equipment, and a longer treatment period for the patient and may cause intranasal polyposis.…”

Efficacy of Transcaruncular approach to reconstruct isolated medial orbital fracture

“…This approach allows direct access to the medial orbital wall and orbital apex without cutaneous incision or disruption of the medial canthus and insertion of reconstructive materials is possible under direct vision. Recent studies have also shown highly successful and safe results by using this approach for medial orbital fracture repair [7][8][9][10][11]13]. A variation of this technique is demonstrated in a recent cadaver study which uses an approach medial to the caruncle, providing a more direct and avascular path to mid orbit [18].…”