title: Upper fornix approach combined with a superior lateral cantholysis: a minimally invasive approach to the superonasal intraconal space.
abstract: OBJECTIVE
  To present a new minimally invasive approach to the deep superonasal orbit.
  
  
  METHODS
  This retrospective study reviewed seven consecutive patients who underwent orbital surgery using an upper conjunctival fornix approach combined with a superior lateral cantholysis for tumors in the superonasal intraconal space. Charts were reviewed for demographic, radiological, clinical, and surgical data including surgical outcome and morbidities for each patient.
  
  
  RESULTS
  Six benign tumors of the superonasal intraconal orbit were successfully exposed and removed using this approach, and one malignant tumor was biopsied for diagnosis. Histopathology revealed cavernous haemangioma (3 cases), solitary fibrous tumor (2 cases), schwannoma (1 case), and diffuse large B cell lymphoma (1 case). Visual acuity and ocular motility were unchanged or improved in all cases. There were no visible scars or other complications related to this approach.
  
  
  CONCLUSIONS
  The upper fornix approach combined with a superior lateral cantholysis is a novel technique that provides safe and excellent exposure of the deep superonasal orbit. In addition, it avoids the unnecessary morbidity of upper lid splitting, medial rectus muscle detachment, or bone removal.
authors.affiliation: Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic 43-gil, Songpa-gu, Seoul, 05505, Korea. lineblue@hanmail.net.
authors.forename: Ho-Seok
authors.initials: HS
authors.lastname: Sa
authors.affiliation: Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Seo
authors.affiliation: Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic 43-gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Sunah
authors.initials: S
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D003228:Conjunctiva / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009918:Orbital Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Intraconal space; Orbitotomy; Superonasal orbit; Transconjunctival approach