Approach

The transconjuntival incision, also called the inferior fornix incision, is a popular approach for exposure of the orbital floor and infraorbital rim. Two basic transconjuntival approaches, the preseptal and retroseptal, have been described. These approaches vary in the relationship of the orbital septum to the path of dissection (Fig. 3-1). The retroseptal approach is more direct than the preseptal approach and easier to perform. The periorbital fat may be encountered during the retroseptal approach, but this is of little concern and causes no ill effects. A lateral canthotomy is frequently used with transconjunctival incisions for improved lateral exposure. The approach that will be demonstrated here is the retroseptal transconjunctival approach with a lateral canthotomy.

The main advantage of tranconjunctival approaches is that they produce excellent cosmetic results because the scar is hidden in the conjunctiva. If a canthotomy is performed in conjunction with the approach, the only visible scar is the lateral extension, which heals with an inconspicuous scar. Another advantage is that these techniques are rapid, and no skin or muscle dissection is necessary.

One disadvantage of the transconjunctival approach is that the medial extent of the incision is limited by the lacrimal drainage system. If access to the medial third of the orbital rim is needed, cutaneous approaches through the lower eyelid should be considered because they allow extension of the incision as far medially as necessary.

Pterygomasseteric Fascia
Figure 3 1 Sagital section through orbit showing preseptal and retroseptal placement of incision.

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