Retroseptal transconjunctival approach for blowout. The presence of infection or neoplasia warrants the transpalpebral approach. Download surgical approaches to the facial skeleton second. The aim of this study is to analyze the transconjunctival approach in the treatment of orbital fractures and to evaluate the indications, the advantages of the surgical approach, and the. Transconjunctival blepharoplasty combined with fat graft ing and 88% phenol peel offers a unique and previously undescribed approach to establishing the ideal aesthetic to the lower eyelid and cheek. Feb 29, 2016 the transconjunctival approach is a better option in patients who express concerns about scarring with the transcutaneous approach. We will focus on the preseptal transconjunctival approach. Transconjunctival sutureless vitrectomy tsv was first introduced in 2002, using 25gauge instruments through a trocarbased system. Two stitches were made laterally from the infraorbital foramina, as described for the tor procedure figure 11. Transconjunctival blepharoplasty allows a scar free rejuvenation of the lower lid and has met with a. Specifically, we have compared the results of this blepharoplasty. Another advantage of the transconjunctival approach is no visible scar on the eyelid.
Materials during the period march 1994 to may 2000, 23 patients underwent esthetic blepharoplasty with a transconjunctival approach. Recovery after transconjunctival blepharoplasty is shorter than traditional eyelid surgery usually only a few days and patients generally experience limited bruising and swelling. Retinal physician comparison of traditional pars plana. The incision was extended to free the fmt tissue from the maxilla.
Read the transconjunctival approach in the trauma setting. Although the resultant transcutaneous scar is almost imperceptible, depigmentation at the scar line sometimes occurs in darkerskinned individuals. I trained using the traditional technique, but now perform lower blepharoplasty using exclusively the transconjunctival and pinch techniques. A lower eyelid forniceal conjunctival incision, when combined with a lateral canthotomy and inferior cantholysis, provides a panoramic exposure of the inferior and lateral orbit. Thus the purpose of this study was to evaluate the clinical efficacy of the transconjunctival preseptal approach for treatment of infraorbital rim and orbital floor fracture. The transconjunctival approach to lower eyelid blepharoplasty involves a precise incision made on the inner lining of the lower eyelid the conjunctival surface rather than the outer skin surface of the eyelid. It is an efficient surgery taking less than approximately 30 minutes to complete in a straight forward case. Transconjunctival upper lid blepharoplasty sciencedirect. Transoral and transconjunctival routes for a middle third. The transconjunctival approach to access the infraorbital rim and orbital floor has recently been reevaluated. The infraorbital nerve and vessels were identified and preserved figure 10. Download surgical approaches to the facial skeleton second edition pdf free. Download the free realself iphone app for faster and easier browsing get the realself iphone app. Transconjunctival plication or reattachment of retractors is easy to perform and allows for the repair of more than the medial portion of the retractors if required.
It allows for easy and safe access to the fat that can be either removed or repositioned over the cheek bone. Over the years, many techniques have been described to correct tear trough deformity ttd. This study investigates the use of a transconjunctival approach to resect and transpose fat combined with a skin flap technique that permits skin excision and simultaneous resurfacing with 30%. Transconjunctival blepharoplasty eyelid surgery new. The transconjunctival approach allows direct delivery of the entire amount of btxa into the lacrimal gland, obtaining resolution of symptoms with only half the dose used transcutaneously, and only infrequent. We have used the transconjunctival approach for the repair of orbital floor and rim on more than 100 cases during over 20 years in japan. However, those methods have disadvantages such as a complicated surgical approach, residual scar, and long recovery time. The transconjunctival approach to lower lid blepharoplasty provides access for both fat resection and transposition to soften tear trough deformities and correct infraorbital fat herniation.
Periorbital fat fills both intraconal and extraconal spaces. Patient confidentiality was maintained and the study was carried out according to the principles adopted by the declaration of helsinki. The file has been uploaded to an online repository for the safe downloading. Complications of this approach, including conjunctival fornix shortening and eyelid margin malposition, have been occasionally reported. Download ebook patient studies in valvular, congenital, and rarer forms of cardiovascular disease. Surgical approaches to the facial skeleton 3rd edition pdf. The transconjunctival blepharoplasty is my favorite approach to lower eyelid surgery. Transconjunctival approach in lower blepharoplasty wikiplastic. Correction of involutional lower eyelid medial ectropion with transconjunctival approach retractor plication and lateral tarsal strip. Because the dissection plane in a transconjunctival approach is entirely posterior to the lacrimal apparatus, the medial incision can be placed medially beyond the lacrimal punctum and by combining this approach with a transcaruncular approach, a wide operative field for the medial orbital wall can be obtained, which is the most advantageous. Advantages of intraoral and transconjunctival approaches. Cureus a case report of scarless direct access to the. Now, in this section of the article, you will be able to get access to the surgical approaches to the facial skeleton 3rd edition pdf free download file in. Fatrepositioning lower blepharoplasty via a transconjunctival approach is increasingly.
Transconjunctival approach in lower blepharoplasty youtube. Transconjunctival blepharoplasty is an ideal way to approach those unsightly bags below your eyes. Hematological complications in obstetrics, pregnancy, and gynecology free pdf. Comparison of traditional pars plana vitrectomy to a transconjunctival approach marc j. At the midwestern section meeting of the american academy of facial plastic and reconstructive surgery, cincinnati, ohio, steven w. Retroseptal transconjunctival approach for blowout fracture. Perkins, md, indianapolis, ind, presented his experience with the transconjunctival approach to lower eyelid blepharoplasty. Transconjunctival botulinum toxin offers an effective. Jun 29, 2018 surgical approaches to the facial skeleton 3rd edition pdf free download section. Our technique for the transconjunctival blepharoplasty and the use of the silent assistant involves five steps.
Discussion has focused primarily on individual surgeon experience with a particular approach, but a singlesurgeon comparison of the 2 publications is lacking. All the patients consented to undergo transconjunctival approach retractor plication and lateral tarsal strip lower eyelid tightening under local anaesthetic in day case surgery. Transconjunctival retractor reinsertion with lateral. Transconjunctival approach to lower eyelid blepharoplasty. The transconjunctival approach to the orbital floor and orbi. The subconjunctival approach had a significantly higher incidence of entropion than the subciliary approach p transconjunctival approaches are associated with specific complications. Despite the fact that transconjunctival approach to lower eyelid blepharoplasty is not a new technique, the indications, patient selection, technique, and results using this technique have not previously been widely reported. Table 2 shows this clinical pathway of lower blepharoplasty. Blepharoptosis correction transconjunctivally using buried. The pinch technique fat is removed via the transconjunctival approach, then a pinch of skin is removed from the front of the eyelid.
Preseptal transconjunctival approach to the orbital floor. By utilizing a transconjunctival approach, we eliminate the need for peritomies at the start of the procedure. The authors describe the surgical technique, its indications and results. Fat excess with good lower eyelid skin quality is indicative of the transconjunctival approach, fat excess with lax skin the transcutaneous approach and poor lid tone with presence of tear trough other auxiliary procedures. The transconjunctival ptosis correction has the added advantage of being cosmetically more acceptable, as minimal scar is visible on the lid. In our estimation, the transconjunctival approach is the best choice to apply for blowout fractures in younger patients, especially in urgent and severe entrapment cases including the missing rectus syndrome. Transconjunctival approach in lower eyelid blepharoplasty. Because of the excellent cosmetic and scar free results, this technique is in vogue. Materials during the period march 1994 to may 2000, 23 patients underwent esthetic blepharoplasty with a. Transconjunctival blepharoplasty my plastic surgeon. We report a case of orbital hemangioma at the same location and larger in size that was removed by a transconjunctival approach with a cryosurgical probe figure. Transconjunctival blepharoplasty and the use of the. Because the scars are inside the lower eyelid where they cannot be seen, this. The significant advantage of transconjunctival approaches is that the scar is hidden in the conjunctiva.
We believe that our study, along with previously published data, supports a blepharoptosis correction transconjunctivally using buried suture method as an effective treatment method. Transconjunctival approach to peribulbar block lindsay a mcgrath,1,2 christopher bradshaw3,4 1university of queensland, school of medicine, brisbane, qld, australia. A transconjunctival approach to the orbit, using a lateral canthal and inferior fornix incision swinging eyelid, was first described by mccord8 in 1981 and recently popularised by rootman and coworkers. It has a lower complication rate than the classic transcutaneous approach. Cataract surgery posted 2142018 this case demonstrates fourpoint fixation with scleralsutured iols. Transconjunctival blepharoplasty eyelid surgery london. The transconjunctival approach to the inferior orbit and orbital fat offers the potential advantage of avoidance of scar creation in the lower eyelid skin and anterior lamellae. Transconjunctival approach to lowerlid blepharoplasty. There are a variety of adjunctive techniques canthoplasty, skin pinch, muscle strap which may be included in surgery which warrant cutaneous incisions and muscle manipulation. Several new approaches have been addedthe transconjunctival approach to the medial orbit, subtarsal approach to the internal orbit, weberferguson approach to the midface, and facial degloving approach to the midface. Transconjunctival approach for retrobulbar intraconal orbital cavernous hemangiomas. The transconjunctival approach was first described in 1924 in the french literature.
Sep 23, 2016 the significant advantage of transconjunctival approaches is that the scar is hidden in the conjunctiva. The transconjunctival preseptal approach is most effective surgical access to infraorbital rim and orbital floor and even to medial orbital wall. Transconjunctival blepharoplasty allows a scar free rejuvenation of the lower lid and has met with a high degree of patient satisfaction. Full text learning curve of sutureless transconjunctival. Transconjunctival lower lid blepharoplasty, first described in 1928, 1 gained tremendous popularity in the 1980s 2 because it significantly reduced the risk of lid retraction associated with the traditional skinmuscle approach. Avoidance of complications, american journal of otolaryngology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Transconjunctival approach for intraorbital tumors jama. Correction of involutional lower eyelid medial ectropion. If a canthotomy is performed in conjunction with the approach, the only visible scar is the lateral extension, which heals leaving an inconspicuous scar. Surgical approaches to the facial skeleton 3rd edition pdf free download section.
Transconjunctival approach to the arcus marginalis release. Transconjunctival orbital fat repositioning for tear trough. Orbital fracture repair outcomes with preformed titanium mesh pdf evolving trends in the management of orbital floor fractures pdf sutureless transconjunctival approach for infraorbital rim pdf virtual surgical planning for orbital reconstruction. Transconjunctival blepharoplasty eyelid surgery new york city. Because of the invisibility of the incision and low incidence of complications, fat repositioning through transconjunctival incision has been suggested as an effective and advantageous method that is preferable to a subciliary transcutaneous approach. It extends from the medial canthal region into or parallel to one of the. May 26, 2011 thus the purpose of this study was to evaluate the clinical efficacy of the transconjunctival preseptal approach for treatment of infraorbital rim and orbital floor fracture. The transconjunctival incision is made through the fornix of conjunctiva, which is believed to reduce the visible cutaneous scarring. This leaves a scar along the eyelid underneath the eyelashes. Transcutaneous approach article pdf available in modern plastic surgery 55. My associate and i reported on our transconjunctival upper lid blepharoplasty technique in 1999. Mar 08, 2018 inferior transconjunctival orbitotomy is a versatile technique that provides a scarless, minimally invasive, and safe approach to extra and intracorneal orbital tumors.
We performed by transconjunctival approach, three tarsoconjunctival spindles, at 4 mm from the free edge, distributed along lower eyelid. It has a lower complication rate than the classic transcutaneous approach, and no case of cyclid retraction has been reported. Download ebook opioid therapy in infants, children, and adolescents pdf free. Apr 01, 2010 comparison of traditional pars plana vitrectomy to a transconjunctival approach marc j. Transconjunctival blepharoplasty is a type of lower eyelid surgery, which is performed without any external incisions. Transconjunctival orbital fat repositioning is a widely used transconjunctival approach in patients with tear trough deformities and extruded orbital fat, without scarring from skin incision. Transconjunctival preseptal approach for orbital floor and. Simple internal fixation method using barbed thread for. Learning curve of sutureless transconjunctival 20gauge vitrectomy gilbert ws simanjuntak,1,2 arief s kartasasmita,3,4 ilias georgalas,5 eustratios v gotzaridis6 1department of ophthalmology, faculty of medicine, christian university of indonesia, jakarta, 2cikini eye institute, cikini cci hospital, jakarta, 3department of ophthalmology, padjadjaran university, jawa barat, 4cicendo eye. Another transconjunctival approach that has been described the repositioning of fat in an. Unfavorable results of eyelid and lacrimal surgery. A transpalpebral or transconjunctival enucleation can be performed. Transconjunctival lower lid blepharoplasty with and without. What is transconjunctival lower eyelid blepharoplasty.
May 20, 2019 as the transconjunctival technique of lower lid blepharoplasty is more widely used and reported, experience suggests that the transconjunctival approach is a safe and effective procedure with minimal complications. Overall, the transconjunctival approach showed the lowest incidence of complications. The monopolar cautery is then used to perform the inferior cantholysis. The author shows how he performs transconjunctival lower blepharoplasty. The results are more aesthetically pleasing than topical creams or ointments and last much longer, up to a. Modified lower blepharoplasty with fat repositioning via. This approach is surgically similar in providing exposure and access, but aesthetically superior to other approaches and has minimal complications. Currently in lower blepharoplasty, the transconjunctival approach indication has been limited to young patients without skin excess and prominence of bags.
This procedure is internal, producing no outside scars and preserves eye shape. Transconjunctival orbital fat repositioning for tear. This video demonstrates a transconjunctival retractor reinsertion with lateral tarsal strip for the treatment of involutional ectropion. A lateral canthotomy is performed with the 15 blade. The transconjunctival approach obviates this possibility. An aesthetic approach article pdf available in indian journal of ophthalmology 6412. This innovative procedure is relatively quick with a speedy recovery time, and no visible scarring. Modified lower eyelid blepharoplasty improves aesthetic outcomes in patients with hypoplastic. Transconjunctival approach to peribulbar block opth.
The transconjunctival approach is a better option in patients who express concerns about scarring with the transcutaneous approach. Since 1981, we have abandoned the classical lateral orbitotomy procedure. The table was created with the use of foam pads and a trash can, on which the horses head is placed during surgery. Transconjunctival refers to a surgical approach to handling lowereyelid fat. Modified lower eyelid blepharoplasty improves aesthetic. Correction of involutional lower eyelid medial ectropion with. Fatrepositioning lower blepharoplasty via a transconjunctival approach is increasingly applied due to its satisfactory rejuvenating effect. Prasad uses transconjunctival laser blepharoplasty to remove, sculpt and reduce the fat under the eye. Recent metaanalytic evidence about the transconjunctival approach for orbital fracture, including zygomatic fracture and blowout fracture, points to the advantage that the transconjunctival approach offers, precisely because it is less complication prone, especially in the treatment of blowout fracture. Traditional lower blepharoplasty anthony youn, md, facs. The results are more aesthetically pleasing than topical creams or ointments and last much longer, up to a lifetime in most patients. Transconjunctival blepharoplasty and the use of the silent assistant.
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