We have used this access without any difficulty to correct medial blowout fractures and for decompressing the orbit.
The lid crease incision is a natural approach to the medial wall. There is no need to retract the globe laterally and thus the postoperative inflammatory symptoms related to the eye are minimized. The approach allows an easy and complete exposure of the medial wall without any difficulty. The superior oblique muscle, which lies close to the ethmoid-frontal junction, is the most important landmark of the superior limit of the surgical field. Immediately below this muscle, the surgeon finds the anterior ethmoid neurovascular bundle. In orbital decompression, bone removal starts from this level toward the orbital floor and posteriorly toward the apex. During the inferior dissection toward the floor, the surgeon naturally works behind the posterior lacrimal crest. No harm is done to the medial canthal ligament or the anterior insertion of the Horner muscle.
Antonio A. V. Cruz, M.D., Ph.D.
Patricia M. S. Akaishi, M.D.
Adriano Baccega, M.D.
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2. Katowitz, J. A., Welsh, M. G., and Bersani, T. A. Lid crease approach for medial wall fracture repair. Ophthalmic Surg.
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