TRANSCONJUNCTIVAL APPROACH IN RECONSTRUCTION OF MEDIAL ORBITAL WALL FRACTURES – A CASE REPORT

Abstract

Background. Isolated medial orbital wall fractures are rare, albeit untoward injuries. They can cause development of horizontal diplopia, enophthalmos and retraction of the globe upon abduction. Conclusions. In correction of medial orbital wall fractures, one has to reduce the herniated orbital fat and cover the bony defect with a transplant – either an osseous autotransplant or an alternative allotransplant. The medial canthus, i.e. medial palpebral ligament, which should not be desinserted, makes the surgical approach to the medial orbital wall more complicated. The classical approach is by a bicoronal incision, which can cause substantial blood loss. Exposure of the inferior part of the fracture often requires an additional inferior palpebral subcilliary approach. The transconjunctival approach through the medial palpebral angle achieves thorough exposure of the entire fracture, the incision is small and blood loss negligible. The medial canthus represents no obstacle with this approach, as we stay dorsal to it throughout the procedure. Moreover, there are no skin incisions or scars with this procedure. The first patient, successfully operated at our institution, is presented in this article.