A modification of the transcoronal flap that enhances orbital exposure and cosmesis

The transcoronal surgical approach for the treatment of orbital disease has become increasingly popular since it affords excellent surgical exposure through a cosmetically acceptable incision. Exposure of the inferior orbit, however, can be difficult due to limited flap mobility in the frontal plane. Increased inferior exposure may be obtained by extending the incision inferiorly in preauricular skin. In children and young adults without excess preauricular skin folds or wrinkling, however, the wound may be quite apparent, compromising cosmesis. To overcome this drawback, we demonstrate a modified transcoronal incision that redirects the inferior limbs into the postauricular sulcus. This incision not only results in superior cosmesis, but avoids important preauricular neurovascular structures and enhances orbital exposure.