orbit

2. Dr Mohsin Fazal
Senior Registrar
Islamic International Dental College

3.  Inferior rim & floor:
 Transcutaneous
 Subciliary
 Subtarsal
 Infraorbital
 Patterson-Ethmoidectomy
 Transconjunctival
 Preseptal
 Postseptal
 Superolateral Orbit
 Lateral Eyebrow
 Supratarsal Fold
 Coronal
 Medial Orbit
 Lynch
 Patterson Ethmoidectomy

4.  Converse in 1944
 Incision approx 2mm
 Skin undermined

5.  Orbicularis oculi traversed till
orbital septum
 The dissection superficial to
orbital septum
 Periosteum incised on anterior
surface of maxilla & Zygoma
 Periosteum is reflected inward
and upward

6. “Skin Only Incision”
 Inferior dissection is carried superficially to
orbicularis oculi muscle till orbital septum is reached.
“Skin-muscle Incision”
 Incision is carried through both skin
and muscle at the same level till the
tarsal plate.

7.  Incision extended laterally by 1-1.5 cm
 Supraperiosteal dissection at
entire lateral orbital rim
 The periosteum is incised in the
middle of lat orbital rim.

8.  Subperiosteal dissection strips tissues from orbital wall

9.  Tessier & Converse in 1973
Lateral Canthotomy Incision:
 Scissors inserted to the depth of
orbital rim and cut in horizontally.
 The lateral canthal tendon released with a vertical
incision
 Scissors used to dissect through small incision in
conjunctiva to free the vestibular conjunctiva

10.  Periosteum is incised, avoiding the lacrimal sac
laterally
 Periosteum over orbital rim and anterior surface of
maxilla, zygoma and orbital floor is reflected

11.  Lateral Eyebrow Incision
 Upper blepheroplasty Incision
 Coronal Incision
 Lateral Canthotomy Incision

12.  Incision placed at outer aspect of eyebrow
 Skin of eyebrow is tented over superior orbital rim
 1.5cm incision made in a beveled fashion parallel to
hair follicles
 Skin incision retracted over ZF suture, orbicularis oculi
muscles fibres incised overlying the rim

13.  Additional undermining and dissection carried out in
inferolateral direction
 Skin and muscle incisions are stepped for more
favorable healing.

14.  Incision is made at upper eyelid crease extending into
the subcutaneous tissue
 Incision retracted laterally and
extended to orbicularis muscle
 Orbicularis oculi and periosteum exposed by sharp
dissection
 Approx 1cm incision is given but
can be extended if required

15.  Subperiosteal dissection of orbit and orbital rim is
performed.
 Lacrimal fossa, a deep concavity in the inferolateral
orbit

16.  1cm area of hairline at incision is shaved
 Incision is carried out through
skin, subcutaneous tissue and
aponeurosis.
 A curvilinear incision given 2 cm behind incision line
extending lateraly parallel to hairline and finally in the
preauricular region

17.  The incision is given through skin, subcutaneous
tissue and aponeurosis.
 The flap may be elevated with finger dissection or
blunt periosteal dissection
 Periosteal incision given 3-4
cm superior to supraorbital
rims extending lateraly till the
superior temporal line

18.  Subperiosteal dissection carried
out till superior orbital rim
 The lateral portion of the flap is dissected
above temporalis fascia upto within 2-4cm
of Zygoma, the flap is dissected inferiorly
to zygomatic arch
 An incision is made through periosteum
along posterior border of zygoma and the
orbital rim, to meet the horizontal periosteal
incision.

19.  Further reflection of flap accomplished by carrying
dissection into the orbit
 Dissection of periosteum around medial and superior
orbital walls retracts the flap to the junction of nasal
bones & lateral nasal cartilage

20.  A vertical curvilinear 1cm incision 5-10mm medial to
insertion of medial canthus
 Incisoin is placed over lateral nasal structures, the
dissection is made medially through skin,
subcutaneous tissue and periosteum.
 The medial canthal tendon and lacrimal sac lie
posterior and superior to the incision.

21. THANK YOU