The transcaruncular approach to the medial orbital wall.
OBJECTIVE
To demonstrate the safety and use of the transcaruncular approach as a surgical technique that provides rapid exposure of the medial orbital wall and apex through a small cosmetic conjunctival incision.


METHODS
The transcaruncular anterior orbitotomy incision is made through the conjunctiva, between the plica and caruncle, with dissection to a subperiorbital plane along the medial orbital wall. This technique was used in 49 patients (58 orbits) between July 1995 and December 2000. The patients' ages ranged from 5 to 89 years (mean, 50 y).


RESULTS
The transcaruncular anterior orbitotomy approach provided appropriate surgical exposure in all cases of orbital decompression for thyroid-related orbitopathy (in 33 orbits [26 patients]); for biopsy of medial orbital or orbital apex masses in 12 patients; and for drainage of an orbital abscess or marsupialization of a mucocele in 7 orbits (6 patients). Five patients (6 orbits) underwent a transcaruncular approach for release of medial rectus entrapment after fracture. The single complication was 1 patient who required a revision procedure for treatment of medial fornix scarring with resolution of diplopia.


CONCLUSIONS
The transcaruncular approach provides a safe, rapid, and cosmetically pleasing surgical approach to the medial orbital wall and orbital apex. This technique can be used for a variety of indications.
Graham
Scott M
SM
Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1093, USA. scott-graham@uiowa.edu
Thomas
Robert D
RD
Carter
Keith D
KD
Nerad
Jeffrey A
JA
D000038:Abscess / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003228:Conjunctiva; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006111:Graves Disease / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009078:Mucocele; D009915:Orbit / Q000601:surgery*; D009916:Orbital Diseases / Q000601:surgery; D009918:Orbital Neoplasms / Q000601:surgery