Eyelid crease incision for lateral orbitotomy

Purpose: The authors describe a surgical incision and technique for lateral orbitotomy that is intended to minimize visible scarring and deformity. Methods: This is a noncomparative, interventional, retrospective case serie s. Other surgical approaches for lateral orbitotomy are briefly reviewed. T he authors' technique includes incision placement within the natural upper eyelid crease, with minimal extension in a relaxed skin tension line; disse ction to the superior and lateral orbital rims in the submuscular plane; an d wide dissection within the subperiosteal space. Criteria are described fo r inclusion of a bone flap in the technique. Results: The eyelid crease incision has been used for exposure of the super olateral diagonal half of the orbit in approximately 600 cases. A variety o f pathologic conditions affecting the orbital bones or the subperiosteal, e xtraconal, or intraconal spaces have been treated. Surgical exposure has be en adequate to achieve the goals of surgery in individual cases, and the co smetic results have been preferable to those the authors achieved using oth er surgical incisions. Conclusions: The eyelid crease incision for lateral orbitotomy allows disse ction in relatively avascular planes, involves minimal transection of orbic ularis muscle and lymphatic channels, and results in negligible postoperati ve scarring. Depending on the size and location of the lesion and the goal of surgery, the eyelid crease incision may be used without a bone flap. How ever, when a bone flap is needed, the incision does not restrict its size.