Transcutaneous Approach in Surgery for Orbital Blowout Fracture

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  • Kuroki Tomoaki
    Department of Plastic and Reconstructive Surgery, Showa University, School of Medicine
  • Yoshimoto Shinya
    Department of Plastic and Reconstructive Surgery, Showa University, School of Medicine

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  • 眼窩吹き抜け骨折（内壁，下壁）に対する経皮的アプローチ

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In the treatment of orbital blowout fracture, we use a lower eyelid incision or medial angle incision. When we make the lower eyelid incision, we cut the skin between the subcilial line and lower orbital rim. This helps us obtain a wide operative field and invisible scar. In the case of a medial canthus incision, we have to cut the medial canthus ligament and anterior and posterior ethmoidal arteries to obtain a suitable operative field. After cutting the medial canthus ligament, accurate suturing of the ligament is subsequently required to maintain the shape of the medial canthus. The orbit must be dissected until we can confirm the edge of all bone defects to collect all orbital contents from paranasal sinuses into the orbit, and a graft is then placed securely over the edge of the bone defect. Reconstruction of the orbital wall is necessary to prevent the re-escape of orbital contents, and is carried out by closing the bone defect using the graft. The transplant materials for grafting should be as thin as possible. In addition, materials that are relatively resistant to infection are needed. The iliac inner plate is thin and will take as living tissue, and can therefore support the orbital contents semi-permanently. The iliac inner plate is thus suitable as a graft material for the orbit.

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