Demonstration of the orbital septum in a pediatric patient
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 01:36
This video demonstrates the thickness of the orbital septum in a pediatric patient. The patient is to undergo levator resection surgery for congenital ptosis. The lid crease has been marked and a 15 blade is used to make an incision along the lid crease marking. The needle tip cautery is then used to dissect through the orbicularis muscle to expose the orbital septum. I think it's reasonable to dissect between the orbicularis muscle and the orbital septum superiorly to expose a broad expanse of orbital septum. Gentle palpation on the globe shows the prolapse of the preaponeurotic fat. The goal is to identify the preaponeurotic fat posterior to the septum. Dissection then proceeds through the orbital septum. Kids have very thick orbital septum. Again palpation of the globe shows the prolapse of the preaponeurotic fat. The preaponeurotic fat can then the grasped with the forceps and dissection can proceed between the preaponeurotic fat and the underlying levator aponeurosis. This is a very important dissection in children with congenital ptosis because the levator can often be infiltrated with fat and difficult to distinguish from the preaponeurotic fat. The insertion of the levator aponeurosis into the tarsus is marked. An additional marking is made to mark the proposed resection.
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