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Surgical Anatomy and Technique

Robert A. Goldberg, MD; Ronald Mancini, MD; Joseph L. Demer, MD, PhD

Arch Facial Plast Surg. 2007;9(6):443-447.

With a detailed understanding of the pertinent surgical anatomy, the transcaruncular approach provides safe access and excellent exposure of the medial orbit and orbital apex. We herein describe our technique of the transcaruncular approach and delineate the pertinent associated surgical anatomy via dissection, magnetic resonance imaging, and histologic examination. The isolated transcaruncular approach provides exposure of the medial orbital floor from the region of the maxilloethmoidal strut to the orbital roof area superior to the frontoethmoidal suture. When combined with an inferior fornix incision, the transcaruncular approach allows for continuous exposure from the frontozygomatic suture laterally to the frontoethmoidal suture medially. Attention to anatomical details promotes creation of an effective and safe caruncular incision. The conjunctival incision should be ample. The orbital septum should be carefully dissected from the posterior surface of the Horner muscle to minimize fat spillage, and the periosteum should be opened widely at the beginning of surgery.

Author Affiliations: Orbital Disease Center (Drs Goldberg and Mancini) and Comprehensive Ophthalmology, Pediatric Ophthalmology and Adult Strabismus Division (Dr Demer) and Department of Neurology (Dr Demer), Jules Stein Eye Institute, David Geffen School of Medicine, University of California–Los Angeles.

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