Transconjunctival anterior orbitotomy
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 02:13
This video demonstrates transconjunctival removal of a lower eyelid lesion. The patient has a history of a palpable lesion in the lower eyelid. Imaging shows that this is likely a cavernous hemangioma. 4-0 silk sutures are placed through the eyelid margin at the level of the tarsus. A trans-conjunctival incision is then made inferior to the inferior border the tarsus. Dissection is then carried out between the orbicularis muscle and the orbital septum. Additional dissection is carried out towards the inferior orbital rim. A 4-0 silk suture is placed through the edge of the conjunctiva and lower lid retractors in order to provide traction. Blunt dissection is then carried out with a cotton-tipped applicator to identify the lesion. The lesion is palpated and visualized. The lesion is posterior to the septum which is expected. The lesion is in the plane of the central fat pad. The freer periosteal elevator is then used to bluntly dissect around the lesion which has the appearance of a cavernous hemangioma. Westcott scissors are then used to complete the excision. The lesion is sent to the pathologist which did confirm the diagnosis of a cavernous hemangioma. The transconjunctival incision is then closed with interrupted 7-0 Vicryl sutures. Many colleagues would not closed this incision. At the conclusion of the
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