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2015 ; 8
(2
): 100-4
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Retrocaruncular approach for the repair of medial orbital wall fractures: an
anatomical and clinical study
#MMPMID26000079
Shen YD
; Paskowitz D
; Merbs SL
; Grant MP
Craniomaxillofac Trauma Reconstr
2015[Jun]; 8
(2
): 100-4
PMID26000079
show ga
The aim of this article is to investigate a retrocaruncular approach for
repairing medial orbital wall fractures. A total of 10 fresh cadaver orbits were
dissected to investigate a transconjunctival approach to the orbit posterior to
the caruncle. Medical records of consecutive patients with medial orbital wall
fractures repaired via a retrocaruncular incision at Wilmer Eye Institute over a
10-year period were retrospectively reviewed. The study was approved by the Johns
Hopkins Medical Institution's Institutional Review Board. Feasibility of this
approach was clearly demonstrated on all cadavers. Horner muscle was observed to
be directly attached to the caruncle and remained undisturbed throughout the
retrocaruncular approach. For each of the 174 patients reviewed, this approach
allowed successful access to the fracture and proper implant placement. The
origin of the inferior oblique muscle was divided in only 19 patients. Sutures
were not used for conjunctival incision closure in any patient. For 120 patients
who underwent acute repair, the percentage with enophthalmos (? 2 mm) decreased
from 34% preoperatively to 4% postoperatively; extraocular motility deficit
decreased from 41 to 11%. Postoperative complications included recurrence of the
preexisting retrobulbar hemorrhage, conjunctival granuloma, and temporary
torsional diplopia, each in one patient. The retrocaruncular transconjunctival
incision is an effective and safe approach for repairing medial orbital wall
fractures with minimal complications. The retrocaruncular incision offers
advantages over dividing the caruncle because Horner muscle is left undisturbed,
and the incision heals well without suturing.