This video demonstrates an inferior orbitotomy surgery using lower lid tranconjunctival incision to access the inferior orbit.
Surgeon: Dr. David Della Rocca, New York Eye and Ear Infirmary of Mount Sinai
Additional Authors: Dr. Bella Wolf and Dr. Harsha S. Reddy, New York Eye and Ear Infirmary of Mount Sinai
Dr. Della Rocca: A 4-0 silk suture is passed in a horizontal mattress fashion, through the lid margin, and placed on a hemostat to provide inferior traction.
The conjunctiva inferior to the tarsus is well-visualized.
Incision through the conjunctiva, four to five millimeters inferior to the tarsal border, is made. The dissection is carried in the preseptal plane here and the lower lid retractors, which are visible as a white sheet, analogous to the levator aponeurosis in the upper lid, is well seen.
A Desmarres retractor, providing inferior traction and countertraction of the retractors superiorly, allow visualisation of the orbital rim. The septum is finally opened inferiorly, at the level of the orbital rim, and the mass is allowed to prolapse forward.
The malleable retractor can provide retraction of the fat and orbital tissues, as well as light retropulsion on the globe, bringing the mass forward. A clamp/cut/cauterize technique is then used. A biopsy of this mass, which is at the level of the lower lid central fat pad, is obtained.
The conjunctiva is closed, using two or three interrupted plain gut sutures. These can be placed in a buried or non-buried fashion. Generally the retractors are not closed as a separate layer. The lower lid transconjunctival incision is an excellent technique for approaching the inferior orbit for repair and to access inferior orbital lesions. There is no external scar and cosmesis is generally excellent. While complications like entropion may occur, they are rare.