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Transcaruncular approach to the medial orbit and orbital apex
N Shorr1, H I Baylis, R A Goldberg
1Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, California, USA.
Objective:
To present a versatile approach to the medial orbit and orbital apex through the caruncle.
Design:
Retrospective, noncomparative, case series with description of surgical technique.
Participants:
Twenty-five consecutive patients underwent orbital surgery by use of a transcaruncular approach.
Intervention:
Inferior and medial wall fracture repair or orbital decompression by means of a transcaruncular or combined transfornix-transcaruncular approach.
Main Outcome Measures:
The surgical indications and complications were recorded for each patient.
Results:
Ten patients (10 orbits) underwent combined inferior and medial orbital wall fracture repair through a combined transfornix-transcaruncular approach. In 8 of 10 (80%) orbits, the inferior oblique muscle was disinserted during surgery. Fifteen patients (24 orbits) underwent orbital decompression surgery for dysthyroid orbitopathy. An isolated transcaruncular approach was used in 5 of 24 orbits, and a combined transfornix-transcaruncular approach was used in 19 of 24 orbits. There were no complications related to either approach.
Conclusions:
Orbital bone removal and fracture reduction may be safely completed through a combined transfornix-transcaruncular approach. The transcaruncular approach provides excellent and safe exposure of the medial orbital wall, and it avoids scarring associated with the Lynch approach.