title: Transection of inferior orbital fissure contents for improved access and visibility in orbital surgery.
abstract: BACKGROUND
  Selective inferior orbital fissure (IOF) content transection for the purpose of surgical access to the posterior orbital floor is a technique that facilitates visualization of the posterior bony ledges of traumatic orbital floor defects. It also has potential advantages in achieving stable placement of reconstructive materials. Although not new, the surgical technique has not yet been described, and the morbidity of the technique has not been quantified. This article describes the procedure and assesses the morbidity specific to the division of related neural structures.
  
  
  METHODS
  The technique and surgical anatomy are described and illustrated with intraoperative photographs. Postoperative assessment of neural structures relevant to the division of IOF contents is performed. These values are compared with the nonoperated side to evaluate the morbidity of the technique.
  
  
  RESULTS
  The technique, which is consistently used by the senior author in the repair of orbital floor defects with very small posterior ledges or which extend to and involve the IOF, facilitates better visualization of the posterior ledge and posterolateral ledge in such cases. Surgical outcomes including facial sensation and lacrimal function on the operated side remain within the reference range and are not significantly different when compared with the contralateral nonoperated side.
  
  
  CONCLUSIONS
  Selective IOF transection aids in the direct visualization of the posterior bony ledges in the repair of posterior orbital floor defects. It therefore may facilitate the placement of reconstructive materials on bony ledges circumferentially, providing stable reconstruction, potentially reducing implant-related complications without causing increased morbidity.
authors.affiliation: From the *Division of Plastic Surgery and †Department of Ophthalmology & Vision Sciences, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario; ‡Clinical Assistant Professor, Division of Plastic Surgery, University of Saskatchewan, Saskatoon, Saskatchewan; and §Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Ricketts
authors.forename: Hall F
authors.initials: HF
authors.lastname: Chew
authors.forename: Ian R P
authors.initials: IR
authors.lastname: Sunderland
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Fialkov
mesh_terms: D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods; D005145:Face / Q000294:innervation; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D007765:Lacrimal Apparatus / Q000294:innervation / Q000502:physiology; D008437:Maxilla / Q000033:anatomy & histology; D008442:Maxillary Nerve / Q000033:anatomy & histology; D009900:Optic Nerve / Q000033:anatomy & histology; D009915:Orbit / Q000033:anatomy & histology / Q000294:innervation / Q000601:surgery*; D009917:Orbital Fractures / Q000601:surgery*; D021362:Palate, Hard / Q000033:anatomy & histology; D010781:Photography / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D012677:Sensation / Q000502:physiology; D012684:Sensory Thresholds / Q000502:physiology; D013100:Sphenoid Bone / Q000033:anatomy & histology; D014110:Touch / Q000502:physiology; D016896:Treatment Outcome; D015050:Zygoma / Q000033:anatomy & histology / Q000294:innervation