The Transcaruncular Approach for the Reduction of Medial Orbital Wall Fracture

ABSTRACT

The evolution of surgical approaches to the medial orbit has been driven by the need to achieve safe, versatile, and direct access, while minimizing unwanted structural changes and scarring. Previous approaches such as medial skin incision or inferior transconjuntival incision have limited overview and may leave visible scar or lid retraction. Transcaruncular approach may successfully resolve such problems and maybe the first choice of method in reduction of medial orbit. The anatomy underlying the transcaruncular approach suggests that it offers the same excellent exposure of the medial wall as the Lynch approach. An incision through the caruncle and dense fibrous condensation passes along a natural plane between Horner's muscle and the medial orbital septum. So minimal bleeding occurs and can exposure the fracture site in the shortest time. We used this method in 22 patients for reduction of medial orbital wall fractures and it provides excellent surgical exposure, easy and rapid, and no visible scar remained.