title: Modified transconjunctival lower lid approach for orbital fractures in East Asian patients: the lateral paracanthal incision revisited.
abstract: BACKGROUND
  Optimal repair of an orbital fracture requires adequate exposure into the orbit. The transconjunctival approach with lateral canthotomy is a valid option in East Asian patients, who are especially sensitive to the appearance of an external skin scar, although one must also recognize the potential complications associated with eyelid aperture mechanics. The authors report the modification of the transconjunctival approach, in which a lateral paracanthal incision is made along with division of the lateral tarsal plate but not at the lateral canthus. This was developed to overcome the complications of traditional lateral cantholysis.
  
  
  METHODS
  A retrospective chart review was performed for all patients who had received the modified transconjunctival incision. Patient demographics, injury characteristics, and surgical outcomes were evaluated.
  
  
  RESULTS
  The baseline demographics of 30 patients in this study was typical of orbital fractures in the Korean population. A take-back operation was required in one case of preseptal hematoma. The mean follow-up period was 6 months, and no long-term functional complications were identified. Of the 30 total patients, 29 showed excellent aesthetic outcome. One patient did present with postoperative notch deformity but did not feel the need for a revision operation.
  
  
  CONCLUSIONS
  The transconjunctival approach with a lateral paracanthal incision is an alternative approach to the orbital wall. The decoupling of the lower eyelid through the lateral portion of the tarsal plate provides excellent exposure of the orbital floor and provides a reliable and consistent landmark by which the anatomy of the eyelid can be restored. The aesthetic and functional outcomes are excellent.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Seoul and Iksan, Republic of Korea; and Palo Alto, Calif. From the Department of Plastic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University; the Department of Plastic and Reconstructive Surgery, School of Medicine, Wonkwang University; and the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center.
authors.forename: Jeonghoon
authors.initials: J
authors.lastname: Song
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Lee
authors.forename: Sung Tack
authors.initials: ST
authors.lastname: Kwon
authors.forename: Suk Wha
authors.initials: SW
authors.lastname: Kim
authors.forename: Eui Cheol
authors.initials: EC
authors.lastname: Jeong
mesh_terms: D000293:Adolescent; D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data*; D002921:Cicatrix / Q000517:prevention & control; D015331:Cohort Studies; D003228:Conjunctiva / Q000601:surgery*; D004954:Esthetics; D005143:Eyelids / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult