Versatile Use of Extended Transconjunctival Approach for Orbital Reconstruction

Abstract

When exposing the orbit, the transconjunctival approach is regarded to have limited surgical exposure. The aim of this study is to demonstrate the versatile usability of extended transconjunctival approach, which can be extended medially and laterally, in reconstruction of medial orbital wall, floor, and even the lateral rim in maxillo-malar complex fracture.We reviewed 122 cases of orbital fractures treated with extended transconjunctival approach. The operative results were assessed by postoperative CT scan and reviewing postoperative complications. The extended transconjunctival approach provided sufficient surgical exposures in all cases. There was no ectropion or scleral show during follow-up period. The cutaneous scars were almost invisible in most cases.The extensile character of this approach makes continuous exposure of the orbit from frontozygomatic suture laterally to the frontonasal suture medially, while minimizing scar and eyelid complications.

Endoscopic Endonasal Versus Transfacial Approach for Blowout Fractures of the Medial Orbital Wall

“…The transconjunctival approach has the advantage of leaving no external scars, but it could provide an inadequately narrow surgical field for the reduction. 4,5,11,12 Endoscopic endonasal surgery was developed in Germany and Japan. [13][14][15][16] It has been applied for several pathologies, such as paranasal sinusitis, cerebrospinal rhinorrhoea, and decompression of optic neuropathy.…”

“…1 Medial wall fractures can be repaired by surgical intervention via various access routes, for example, transcutaneous approach, transconjunctival approach, and endoscopic endonasal approach. [2][3][4][5][6] Each approach has its advantages and disadvantages. The choice of approach depends on the anatomic location of the fracture and on its extent.…”

Subtarsal Versus Transconjunctival Approach—Esthetic and Functional Long-Term Experience

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][16][17][18][19][20][21][32][33][34][35][36][37][38][39][40][41][42] or "inconspicuous", with or without further differentiation as "hypertrophic" or "nonhypertrophic." 3,8,10,39 In our study, consideration of several aspects of scar formation according to criteria of the mVSS results in more representative and valid findings. Here, the application of the mVSS as a comparable scale for rating scars is, to our knowledge, unique for the assessment of orbital approaches.…”

Transconjunctival Inferior Orbitotomy: Indications, Surgical Technique, and Complications

“…Early transient complications can include edema, epiphora, chemosis, trichiasis, and diplopia. 24,52 Later complications include conjunctival granuloma, ectropion, entropion, intractable chemosis, lower lid retraction, and lower lid malposition secondary to postoperative scar and excessive retraction (►Fig. 8).…”