Lateral orbitotomy 1
This is Richard Allen at the University of Iowa. This video demonstrates a lateral orbitotomy using a lateral canthal incision to excise a presumed cavernous hemangioma.
A lateral canthotomy and superior and inferior cantholysis are performed with the monopolar cautery.
4-0 silk suture are placed through the lateral upper and lower lid to provide traction during the case.
Dissection will then be carried out to the lateral orbital rim by dissecting along the posterior surface of the orbicularis muscle.
The periosteum of the lateral orbital rim is then incised with the monopolar cautery.
A Freer periosteal elevator is then used to elevate the periosteum both extraorbitally and intraorbitally.
Intraorbitally the periosteum is elevated from the lateral orbital wall.
The periorbita is then incised in the area of the tumor, which is in the inferior temporal quadrant in this patient.
Blunt dissection is then performed inferior to the lateral rectus muscle with small malleable retractors through the orbital fat. Doing this results in palpation of the tumor.
Yasargill scissors are used to dissect through the orbital septae. The tumor is then exposed and delivered with gentle pressure.
In this case, front biting forceps are used to engage the tumor and slowly pull it free from the surrounding fat.
The tumor has the clinical appearance of a cavernous hemangioma which was confirmed by the pathologist.
Hemostasis is attained with bipolar cautery.
The cantholyses are repaired by engaging the periosteum with a 4-0 Vicryl suture which then engages the lateral upper lid, followed by the lateral lower lid, followed by the periosteum.
This is a single circular stich, which, when tied, repositions the lateral canthus appropriately.
The canthotomy is then repaired with interrupted 5-0 fast absorbing sutures.