title: The Revised Direct Transconjunctival Approach to the Orbital Floor.
abstract: OBJECTIVE
  To review common surgical approaches to the orbital floor and to evaluate the utility of canthal-sparing, single incision transconjunctival method.
  
  
  METHODS
  A retrospective chart review of a consecutive series of patients who underwent transconjunctival, direct incision surgery without eyelid dissection or lateral canthotomy and inferior cantholysis and review of the literature were conducted.
  
  
  RESULTS
  Twenty-three consecutive patients (33 orbits) were operated using a canthal-sparing direct single cut approach, including 10 unilateral pediatric orbital floor fractures, 1 orbital floor implant removal, 2 unilateral post-traumatic enophthalmos repairs, and 10 bilateral orbital floor decompressions. Surgical exposure was adequate to complete the surgical objective in each patient. Mean follow up was 13 months and no complications were observed.
  
  
  CONCLUSIONS
  The transconjunctival approach to the orbital floor can be performed using a pre- or post-septal dissection, with infratarsal or fornix incision commonly associated with lateral canthotomy and inferior cantholysis. The direct approach spares the lateral canthus, minimizes lower eyelid dissection, and provides rapid and effective access to the inferior orbital rim and orbital floor. It offers sufficient exposure to allow insertion of large floor implants even in children. Although apparently abandoned in the recent literature, canthal-sparing technique is a useful method for the management of orbital floor fractures, enophthalmos correction, implant removal, and orbital decompression.
authors.affiliation: *Oculoplastica Bernardini, Genova, Italy; †Cincinnati Eye Institute, Cincinnati, Ohio, USA; ‡Harvard Medical School, Boston, Massachusetts, USA; §Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: Francesco P
authors.initials: FP
authors.lastname: Bernardini
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Nerad
authors.forename: Aaron
authors.initials: A
authors.lastname: Fay
authors.forename: Alessandra
authors.initials: A
authors.lastname: Zambelli
authors.forename: Antonio Augusto V
authors.initials: AA
authors.lastname: Cruz
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003228:Conjunctiva / Q000601:surgery*; D005260:Female; D006801:Humans; D007765:Lacrimal Apparatus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009917:Orbital Fractures / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D055815:Young Adult; D015051:Zygomatic Fractures / Q000601:surgery