Usefulness of Subciliary Approach by Using Lacrimal Sac Stripping for Large Isolated Medial Orbital Fracture Reconstruction.

Abstract

There are several approaches for isolated medial orbital wall reconstruction, such as subciliary, transcaruncular, bicoronal, and medial canthus skin approach. Among them, selecting the best method has been controversial. The purpose of this study was to determine the safety and effectiveness of the subciliary approach by using lacrimal sac stripping for large isolated medial orbital wall reconstruction. We conducted a retrospective study of patients with medial orbital fracture during the previous 5 years (January 2007-December 2011). The medical data of 20 patients, who presented with isolated medial orbital fracture and treated via subciliary approach using lacrimal sac stripping, were reviewed. The extent of the defect and plate size, follow-up details, and complications were analyzed. There were 16 male and 4 female patients. According to preoperative/postoperative computed tomography, the vertical defect ranged from 8 to 22 mm, longitudinal defect ranged from 10 to 27 mm, vertical plate length ranged from 11 to 28 mm, and longitudinal plate length ranged from 16 to 30 mm. The mean follow-up period was 24.7 weeks. Two patients complained of postoperative complications, inevitable traumatic optic neuropathy, and persistent diplopia on extreme lateral gaze. However, there were no other problems of enophthalmos, lower eyelid scar formation, postoperative ectropion, or lacrimal apparatus injury. Subciliary approach by using lacrimal sac stripping method offers a safe access route to the defect, satisfactory exposure, as well as sufficient room for insertion of large implant, without significant postoperative morbidity.