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Published on: March 26, 2016
Post-operative epiphora following the transcutaneous medial canthal incision
Mark A Prendes1, John Mittel2, Peter J Timoney3
1Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, USA; Oculofacial Plastic and Orbital Surgery, Indianapolis, IN, USA; University Hospitals Eye Institute, Cleveland, OH, USA.
Purpose:
The safety profile of the transcutaneous medial canthal incision for access to the medial orbit is assessed with a focus on the risk of post-operative iatrogenic epiphora.
Methods:
A retrospective chart review of patients undergoing medial orbitotomy via the transcutaneous medial canthal incision was performed. Patients with a minimum of 3 months of follow-up were included and post-operative complications were assessed and characterized.
Results:
One-hundred-fifty patients were included in the study. A total of 4 complications were identified, including one each of the following: nasolacrimal duct obstruction, hypertrophic scar, suture granuloma and soft tissue infection. Only the nasolacrimal duct obstruction required surgical intervention.
Discussion:
Access to the medial orbit has been achieved through a variety of approaches, each with their own benefits and risk profile. The transcaruncular approach has increased in usage as a means to avoid a visible cutaneous scar and decrease the risk of iatrogenic epiphora, however, there are specific patients who may have relative contraindications to this approach. The current study demonstrates the low risk profile of the transcutaneous medial canthal incision, specifically the minimal risk of iatrogenic damage to the nasolacrimal outflow system. This approach is another useful tool which orbit surgeons should be familiar with to offer as an option to patients requiring medial orbitotomy.
Insights
The transcutaneous medial canthal incision for medial orbitotomy has a low complication rate, with minimal risk of damaging the nasolacrimal system. This safe surgical approach offers another option for orbit surgeons.
Area of Science:
- Ophthalmology
- Surgical Oncology
- Plastic Surgery
Background:
- Access to the medial orbit is crucial for various surgical procedures.
- Traditional approaches carry specific risks, including visible scarring and potential iatrogenic epiphora.
- The transcaruncular approach is increasingly used to mitigate these risks.
Purpose of the Study:
- To evaluate the safety and complication profile of the transcutaneous medial canthal incision for medial orbitotomy.
- To specifically assess the risk of post-operative iatrogenic epiphora associated with this approach.
Main Methods:
- A retrospective review of patient charts was conducted.
- Patients undergoing medial orbitotomy via transcutaneous medial canthal incision were included.
- A minimum follow-up of 3 months was required to assess post-operative complications.
Main Results:
- 150 patients were included in the study.
- Four complications were identified: nasolacrimal duct obstruction, hypertrophic scar, suture granuloma, and soft tissue infection.
- Only the nasolacrimal duct obstruction necessitated surgical intervention.
Conclusions:
- The transcutaneous medial canthal incision demonstrates a low-risk profile for medial orbitotomy.
- This approach presents a minimal risk of iatrogenic damage to the nasolacrimal outflow system.
- It serves as a valuable alternative surgical option for patients requiring medial orbitotomy.
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