Retroseptal Transconjunctival Approach for Blowout Fracture of the Orbital Floor: An Ideal Choice in East-Asian Patients

When repairing an orbital fracture, the inferior orbital floor needs to be exposed. For that exposure, either a transcutaneous or a transconjunctival approach can be taken. The transconjunctival approach was first described by Bourquet1 in 1924 for the removal of lower eyelid fat. Tessier2 later advocated this approach, in 1973, for exposure of the orbital floor and the maxilla for the treatment of facial traumas and maxillofacial anomalies. The transconjunctival approach provides the surgeon with an ample enough surgical site in which to work on the orbit’s inferior surface, leaving no visible scar and reducing the risk of complications often associated with transcutaneous techniques.3,4 The transconjunctival approach is not only useful for aesthetic purposes but also facilitates exposure of the orbital floor in East-Asian patients. East Asians are anatomically different from Caucasians in that their lower eyelids are characterized by puffiness. This East-Asian trait in anatomy serves as a merit when it comes to exposing the orbital floor using a retroseptal approach. Our technique is based on what the first author of this article (Uemura) had acquired and refined while he trained under Dr. David J. David of the Australian Craniofacial Unit in Adelaide, S.A., between November 1993 and March 1994.