Lateral orbitotomy 3
This is Richard Allen at the University of Iowa. This video demonstrates a lateral orbitotomy using a lateral canthal incision in a patient with a presumed cavernous hemangioma.
A lateral canthotomy and inferior and superior cantholysis are performed with the needle tip cautery.
4-0 silk suture is then placed through the lateral upper and lower lid to provide traction during the case.
Dissection is carried out to the lateral orbital rim.
Desmarres and malleable retractors provide exposure to the rim. The periosteum of the lateral orbital rim is incised with the monopolar cautery.
The periosteum is then elevated off of the lateral orbital rim and lateral orbital wall with the Freer periosteal elevator.
Along the lateral orbital wall one often encounters the zygomaticofacial and zygomaticotemporal neurovascular bundles. This tumor is in the inferior lateral quadrant.
Westcott scissors are used to make an incision through the periorbita in this quadrant.
Blunt dissection is then carried out with narrow malleable retractors through the orbital septa to expose the orbital fat.
The malleable can usually palpate the tumor and blunt dissection with the malleables as well as cotton tip applicators results in exposure of the tumor.
The tumor is visualized, and in this case, a cryo tip will be used to engage the tumor and slowly deliver it from the orbit.
The tumor has the gross appearance of a cavernous hemangioma which was confirmed by the pathologist.
Repair of the cantholysis is performed by engaging the periosteum of followed by the lateral lower lid, followed by the lateral upper lid, and finally the periosteum again.
This is a 4-0 Vicryl suture on a P-2 needle which, when tied, repositions the lateral canthus appropriately.
The lateral canthotomy is then closed with a deep interrupted 4-0 Vicryl suture followed by superficial interrupted 5-0 fast absorbing sutures.