A Modified Incision Technique Combining the Swinging Eyelid Approach With Lateral Paracanthal Incision

The transconjunctival approach is one of the most frequently used surgical approaches that requires surgical exposure in the orbit, such as orbital bone fractures and infraorbital tumors, with less scarring and fewer postoperative complications, such as ectropion. However, the transconjunctival approach alone is limited in its exposure; hence, the swinging eyelid approach with lateral canthotomy is used, especially when a large surgical field extending to the medial and lateral walls of the orbit is required. However, although a large surgical field can be obtained, there is a risk of complications due to misalignment of the divided lateral canthus when it is refixed. To address this problem, the authors developed a new incision technique using a swinging eyelid approach in combination with lateral paracanthal incision. In this technique, instead of a horizontal skin incision at the lateral canthus, a small incision is made in the full layer of the lower eyelid to create a small eyelid flap extending from the lateral canthus, to obtain a large surgical field and to reduce complications during closure. The authors performed this technique in 5 patients with infraorbital tumors and were able to reliably resect the tumors with a large surgical field. There were no problems in closing the wound, and no postoperative complications occurred. This technique is useful when a wide field of view is needed for diseases in the infraorbital region.