Anterior Orbitotomy with Inferior Rim Incision
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This is Richard Allen at the University of Iowa. This video demonstrates an anterior orbitotomy via an approach that I seldom use. The patient has a mass in the inferior medial orbit which is palpable. An incision is going to be made through the skin and orbicularis muscle at the level of the inferior orbital rim. Usually I would approach this area through a transconjunctival or subciliary incision. For various reasons, the patient is not a good candidate for either of these incisions. The orbital septum is identified and dissection is carried along the surface of the orbital septum to the inferior orbital rim. The mass is identified and a Freer periosteal elevator is used to dissect around the mass and mobilize it. The patient is suspected to have a chronic orbital inflammation and has been worked up with serologies with no confirmation of a diagnosis. A tissue sample is thus being obtained to aid in diagnosis. The mass proves to be very tough as is expected with a chronic inflammation. Scissors are used to excise a portion of the mass to aid in visualization. As much of the mass is excised as possible without causing problems. The incision should be simply closed with a superficial layer of running or interrupted sutures. No deep sutures should be placed as this could cause retraction. 5-0 fast absorbing sutures are used here in an interrupted fashion. Antibiotic ointment is placed over the incision and the patient returns in one week for reevaluation.
