Date post: | 21-Mar-2017 |
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Health & Medicine |
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Dr Mohsin FazalSenior Registrar
Islamic International Dental College
SURGICAL APPROACHES TO THE ORBIT
Inferior rim & floor: Transcutaneous
Subciliary Subtarsal Infraorbital Patterson-Ethmoidectomy
Transconjunctival Preseptal Postseptal
Superolateral Orbit Lateral Eyebrow Supratarsal Fold Coronal
Medial Orbit Lynch Patterson Ethmoidectomy
ORBITAL APPROACHES
Converse in 1944
Incision approx 2mm
Skin undermined
SUBCILIARY INCISION
Orbicularis oculi traversed till orbital septum The dissection superficial to orbital septum
Periosteum incised on anterior surface of maxilla & ZygomaPeriosteum is reflected inward and upward
Contd…
“Skin Only Incision”
Inferior dissection is carried superficially to orbicularis oculi muscle till orbital septum is reached.
“Skin-muscle Incision”Incision is carried through both skin and muscle at the same level till the tarsal plate.
MODIFICATIONS
Incision extended laterally by 1-1.5 cm
Supraperiosteal dissection at entire lateral orbital rim The periosteum is incised in the middle of lat orbital rim.
EXTENDED LOWER EYELID APPROACH
Subperiosteal dissection strips tissues from orbital wall
Contd…
Tessier & Converse in 1973 Lateral Canthotomy Incision:Scissors inserted to the depth of orbital rim and cut in horizontally.The lateral canthal tendon released with a
vertical incisionScissors used to dissect through small
incision in conjunctiva to free the vestibular conjunctiva
TRANSCONJUNCTIVAL APPROACH
Periosteum is incised, avoiding the lacrimal sac laterally
Periosteum over orbital rim and anterior surface of maxilla, zygoma and orbital floor is reflected
Lateral Eyebrow Incision
Upper blepheroplasty Incision
Coronal Incision
Lateral Canthotomy Incision
SUPERIOR & MEDIAL APPROACH
Incision placed at outer aspect of eyebrowSkin of eyebrow is tented over superior
orbital rim1.5cm incision made in a beveled fashion
parallel to hair follicles
Skin incision retracted over ZF suture, orbicularis oculi muscles fibres incised overlying the rim
LATERAL EYEBROW INCISION
Additional undermining and dissection carried out in inferolateral direction
Skin and muscle incisions are stepped for more favorable healing.
Incision is made at upper eyelid crease extending into the subcutaneous tissue
Incision retracted laterally and extended to orbicularis muscleOrbicularis oculi and periosteum exposed by
sharp dissectionApprox 1cm incision is given but can be extended if required
BLAPHEROPLASTY INCISION
Subperiosteal dissection of orbit and orbital rim is performed.
Lacrimal fossa, a deep concavity in the inferolateral orbit
1cm area of hairline at incision is shaved
Incision is carried out through skin, subcutaneous tissue and aponeurosis.
A curvilinear incision given 2 cm behind incision line extending lateraly parallel to hairline and finally in the preauricular region
CORONAL INCISION
The incision is given through skin, subcutaneous tissue and aponeurosis.
The flap may be elevated with finger dissection or blunt periosteal dissection
Periosteal incision given 3-4 cm superior to supraorbital rims extending lateraly till the superior temporal line
Subperiosteal dissection carried out till superior orbital rimThe lateral portion of the flap is dissected above temporalis fascia upto within 2-4cm of Zygoma, the flap is dissected inferiorly to zygomatic archAn incision is made through periosteum along posterior border of zygoma and the orbital rim, to meet the horizontal periosteal incision.
Further reflection of flap accomplished by carrying dissection into the orbit
Dissection of periosteum around medial and superior orbital walls retracts the flap to the junction of nasal bones & lateral nasal cartilage
A vertical curvilinear 1cm incision 5-10mm medial to insertion of medial canthus
Incisoin is placed over lateral nasal structures, the dissection is made medially through skin, subcutaneous tissue and periosteum.
The medial canthal tendon and lacrimal sac lie posterior and superior to the incision.
LATERAL NASAL APPROACH
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