Transcaruncular approach to the medial orbit and orbital apex.

Abstract Objective To present a versatile approach to the medial orbit and orbital apex through the caruncle. Design Retrospective, noncomparative, case series with description of surgical technique. Participants Twenty-five consecutive patients underwent orbital surgery by use of a transcaruncular approach. Intervention Inferior and medial wall fracture repair or orbital decompression by means of a transcaruncular or combined transfornix-transcaruncular approach. Main outcome measures The surgical indications and complications were recorded for each patient. Results Ten patients (10 orbits) underwent combined inferior and medial orbital wall fracture repair through a combined transfornix-transcaruncular approach. In 8 of 10 (80%) orbits, the inferior oblique muscle was disinserted during surgery. Fifteen patients (24 orbits) underwent orbital decompression surgery for dysthyroid orbitopathy. An isolated transcaruncular approach was used in 5 of 24 orbits, and a combined transfornix-transcaruncular approach was used in 19 of 24 orbits. There were no complications related to either approach. Conclusions Orbital bone removal and fracture reduction may be safely completed through a combined transfornix-transcaruncular approach. The transcaruncular approach provides excellent and safe exposure of the medial orbital wall, and it avoids scarring associated with the Lynch approach.