Executive Editor: Edward Ellis III, Kazuo Shimozato General Editor: Daniel Buchbinder

Authors: Carl-Peter Cornelius, Nils Gellrich, Søren Hillerup, Kenji Kusumoto, Warren Schubert, Stefano Fusetti, Coauthors: Enno-Ludwig Barth, Harald Essig

Midface

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Glossary

Superolateral orbital rim
Approaches to the superolateral orbital rim enlarge

Overview

There are two periorbital approaches to the superolateral rim of the orbit:

The appropriate choice of approach may vary, depending on tradition in different geographic areas.


Approaches to the superolateral orbital rim enlarge

Access area

The lateral eyebrow approach gives rather limited access to zygomaticofrontal process and the immediate vicinity of suture line (superolateral orbital rim).
The brow skin is thick and the wound edges are not very yielding to retraction but the overall skin mobility allows the shifting of the wound pocket over the bony surface, thus somewhat increasing the field of exposure by varying the traction vector. The entry into the superolateral internal orbit is very restricted and it is difficult to gain much exposure of the sphenozygomatic suture line. A lateral extension of the incision outside the brow to widen the approach will cause conspicuous scarring. Inferior extensions will cross the relaxed skin tension lines (RSTL).


Approaches to the superolateral orbital rim enlarge

The upper-eyelid or upper blepharoplasty approach offers greater versatility and enhanced accessibility to the superolateral rim compared to the lateral eyebrow approach. The soft tissues of the upper lid are thin, resilient, so that the incision site can be easily maneuvered onto the bony surfaces. In addition the incision can be extended laterally across the lateral orbital rim above the lateral canthus insertion without aesthetic drawbacks. Particularly the lower portion of the lateral rim is exposed more readily and the lateral orbital wall can be inspected more widely.

The upper eyelid in East Asian patients does not as readily lend itself to the use of the upper eyelid approach to the lateral orbital rim. In such patients, the lateral eyebrow approach may be a better surgical approach.


Approaches to the superolateral orbital rim enlarge

Link to detailed descriptions

Follow the links to read detailed step-by-step descriptions of the transconjunctival lower-eyelid approaches:

v1.0 2009-12-03