Efficacy of Transcaruncular approach to reconstruct isolated medial orbital fracture

Traditional approaches used to repair medial orbital wall fracture include transcutaneous incision such as advocated by Killian and Lynch, or coronal approach. Transcaruncular approach provides an anatomically safe and efficient alternative, allowing generous exposure without the cutaneous scar.

Patients presenting with medial orbital wall fractures were identified through the trauma database over a 5 year period. Data of twelve consecutive patients who presented with isolated medial wall fracture and treated via a transcaruncular approach were analysed. The extent of the injury, operative and follow up details were documented.

There were ten male patients and two female patients. On computed tomography, vertical defect ranged from 8 to 16 mm (mean 12 mm) and longitudinal defect ranged from 14 to 31 mm (mean 22 mm). All but three patients were followed up for 9 months postoperatively. Two patients were assessed as having a slightly enlarged caruncle on the operated side, but neither patient was aware of this. Of the 2 patients who complained of diplopia, only one had objective restriction beyond 30° of abduction from primary gaze.

Transcaruncular approach allows satisfactory exposure for repair of isolated medial orbital wall fracture. It is an anatomically safe and efficient technique, with superior cosmetic result. Postoperative morbidity is minimal and follow up data demonstrates no permanent complications.