Combined transconjunctival–eyebrow approach providing minimally invasive access to all orbital quadrants

Abstract

✓Surgical approaches to treat orbital disease should provide a good exposure of intraorbital anatomical structures, allow their functional preservation, and provide good cosmetic results. The authors describe a minimally invasive, combined transconjunctival–eyebrow approach to all orbital quadrants in a step-wise manner. The indications, advantages, and limitations of the technique are highlighted. A transconjunctival approach via the postseptal area is described. It allows exposure of the medial, inferior, and lateral parts of the orbit. Depending on the orbital space to be exposed, a lateral or a medial eyebrow incision is then made. The eyebrow and the conjunctival incisions are connected by subperiosteal dissection. This combined access provides exposure to all intraconal muscles and to the superior, medial, lateral, and inferior portions of the optic nerve. The combined transconjunctival–eyebrow approach provides an excellent orbital exposure, with minimal damage to the circumjacent structures. It requires less operative time than other approaches and yields good cosmetic results. Intracranial or intrafacial tumor extension and tumors located purely in the orbital apex are limitations for the use of this technique.