Microsurgical transconjunctival approach to the orbits. Initial retrospective analysis of experiences with the transconjunctival approach in 15 patients. Clinical and surgical aspects

Abstract

The authors report 4-year follow-up results for their first 15 consecutive tumor patients, who underwent transconjunctival surgery of their orbital lesions without muscle dissection. Presentation, natural history, management, surgical appraisal of the transconjunctival approach and its indications are discussed. At follow-up, 14 of the patients showed excellent cosmetic and functional results. Our experience with the transconjunctival approach in the past 4 years suggests that this approach remains a useful modality, with good intraoperative visibility and minimal postoperative scar formation, for managing selected patients with space-occupying lesions located in the inferior medial and basal compartment of the orbit. Not suitable for the transconjunctival approach are deep intraconal lesions (orbital apex) and extraconal superior lesions. The rare problems with the transconjunctival approach have included temporary eye muscle injury with ophthalmoplegia postoperatively. More recently, the use of the transconjunctival approach has allowed surgeons to reduce cosmetic failures, functional deficits and deformities of the orbit. Because of its low risks, the absence of postoperative bleeding, and the absence of prolongation of hospitalization or immobilization of the patients, the transconjunctival approach is a successful procedure, especially in elderly multimorbid patients.