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The Usability of the Upper Eyelid Crease Approach for Correction of Medial Orbital Wall Blowout Fracture

Kim, Hak Su M.D.; Kim, Seong Eon M.D.; Evans, Gregory R. D. M.D.; Park, Sun Hee M.D.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 898–905
doi: 10.1097/PRS.0b013e318262f3d9
Pediatric/Craniofacial: Original Articles
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Background: There are many approaches to the medial orbital wall. However, most of them have problems with limitation of exposure, scarring, and postoperative inflammatory symptoms related to the eye. The authors used an upper eyelid crease approach to overcome these problems and investigate the usefulness of this approach.

Methods: Between 2009 and 2011, the authors used this approach in 22 patients with medial orbital wall fractures. Incisions were performed on the medial one-third of the crease and a 2- to 3-mm superomedial extension along a relaxed skin tension line.

Results: Postoperative computed tomographic scans demonstrated complete reduction and accurate reconstitution of the bony defect in all cases. The initial two cases had revision to correct the implant position. Follow-up ranged from 8 to 28 months, with an average of 12 months. Complications related to the operation were not observed. Diplopia and limitation of eye movement resolved in most cases. Two patients had persistent diplopia for more than 6 months that decreased with time. Enophthalmos of more than 2 mm was not observed in any orbit. The operative scar was inconspicuous.

Conclusions: This approach provides several advantages, including ease of exposure, and is more familiar to the plastic surgeon than the transconjunctival approach. There is little need to retract the globe laterally, thus minimizing postoperative inflammatory symptoms related to the eye. Therefore, the authors suggest that this method should be considered as a natural and useful surgical approach to medial orbital blowout fractures.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Pohang, South Korea; and Orange, Calif.

From the Department of Plastic and Reconstructive Surgery, SM Christianity Hospital, and the Aesthetic and Plastic Surgery Institute, Medical Center, University of California, Irvine.

Received for publication March 16, 2012; accepted April 9, 2012.

Presented at the 68th Congress of the Korean Society of Plastic Surgeons, in Seoul, South Korea, November 4 through 7, 2010.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Hak Su Kim, M.D., Department of Plastic and Reconstructive Surgery Pohang SM Christianity Hospital 94-5 Daedo-dong Nam-kuPohang-si, Gyeongsangbuk-do 790-822, South Korea pskimhs@yahoo.com

©2012American Society of Plastic Surgeons