Cutaneous approaches to the orbital skeleton and periorbital structures

Area of Science:

• Ophthalmology
• Plastic Surgery
• Anatomy

Background:

• Surgical approaches to the orbit require careful consideration of both aesthetic outcomes and functional preservation.
• The unique anatomical features of the superior and inferior orbital regions necessitate specific incisional strategies.

Purpose of the Study:

• To review and analyze various cutaneous approaches for superior and inferior orbital surgery.
• To guide optimal incisional choices based on facial aesthetics and orbital function.

Main Methods:

• Review of established surgical techniques for accessing the superior and inferior orbit.
• Analysis of incisional options including blepharoplasty, ciliary, conjunctival incisions, and bicoronal flaps.
• Consideration of anatomical landmarks and functional requirements for each approach.

Main Results:

• Superior orbit is best accessed via a blepharoplasty incision, potentially with a lateral extension.
• Inferior orbit offers multiple approaches (ciliary, blepharoplasty, conjunctival) with no clear aesthetic superiority except for the conjunctival incision alone.
• Bicoronal flaps provide extensive exposure for the orbital skeleton in non-hair-bearing areas.

Conclusions:

• Optimal orbital surgery incisional choices depend on a thorough understanding of regional anatomy and balancing esthetics with function.
• Careful preoperative and postoperative assessment of orbital function and globe protection are crucial, especially with lid incisions.
• Postoperative recovery for orbital procedures may be prolonged due to tissue thinness, leading to potential edema and bruising.