Transcaruncular approach for reconstruction of medial orbital wall fracture

Medial orbital wall fractures can cause horizontal diplopia and enophthalmo s. Therefore, reconstruction of displaced medial wall fractures should be c onsidered. We used a transcaruncular approach in five male patients to reco nstruct the medial orbital wall after acute injuries and also as a secondar y procedure for enophthalmos correction. Four of these patients had a conco mitant orbital floor fracture. The incision was made in the caruncule and e xtended in the conjunctiva superior and inferior into the fornices for 10-1 2 mm. The tissue was bluntly dissected in an anteroposterior direction. The periosteum was incised dorsal of the posterior lacrimal crest and after el evation of the periosteum, the fractured orbital wall was visible. Transpla nts up to a height of 2 cm could be inserted for reconstruction of the medi al orbital wall. In the cases of acute trauma, the medial wall was reconstr ucted using a resorbable polydioxanone plate. Cortical bone was used for th e reconstruction of late enophthalmos. No postoperative complications were found. The transcaruncular approach gave a rapid entry to the fractured med ial orbital wall without a visible scar.