Transcaruncular approach to the medial orbit and orbital apex

Objective: To present a versatile approach to the medial orbit and orbital apex through the caruncle. Design: Retrospective, noncomparative, case series with description of surg ical technique. Participants: Twenty-five consecutive patients underwent orbital surgery by use of a transcaruncular approach. Intervention: Inferior and medial wall fracture repair orbital decompressio n by means of a transcaruncular or combined transfornix-transcaruncular app roach. Main Outcome Measures: The surgical indications and complications were reco rded for each patient. Results: Ten patients (10 orbits) underwent combined inferior and medial or bital wall fracture repair through a combined transfornix-transcaruncular a pproach. In 8 of 10 (80%) orbits, the inferior oblique muscle was disinsert ed during surgery. Fifteen patients (24 orbits) underwent orbital decompres sion surgery for dysthyroid orbitopathy, An isolated transcaruncular approa ch was used in 5 of 24 orbits, and a combined transfornix-transcaruncular a pproach was used in 19 of 24 orbits. There were no complications related to either approach. Conclusions: Orbital bone removal and fracture reduction may be safely comp leted through a combined transfornix-transcaruncular approach. The transcar uncular approach provides excellent and safe exposure of the medial orbital wall, and it avoids scarring associated with the Lynch approach, Ophthalmo logy 2000;107: 1459-1463 (C) 2000 by the American Academy of Ophthalmology.