Repair of orbital floor fracture without canthotomy/cantholysis
This is Richard Allen at the University of Iowa. This video demonstrates repair of a left orbital floor fracture through a transconjunctival incision without a canthotomy/cantholysis. 4-0 silk suture is used to provide traction. The transconjunctival incision is then made with the monopolar cautery. Dissection is then carried out between the orbicularis muscle and orbital septum to the inferior orbital rim. A 4-0 silk suture is then place through the edge of the conjunctiva to provide traction. A malleable retractor is used to expose the rim and the monopolar cautery is used to incise the periosteum. A freer periosteal elevator is then used to elevate the periosteum from the orbital floor. The fracture is identified in the orbital floor and the tissue is released from all edges of the fracture. A Supramid implant is then fashioned to cover the fracture and placed in a subperiosteal plan to cover the fracture. The implant is then fixated to the inferior orbital rim. A hole is drilled followed by placement of one or two screws. Examination is then performed to insure that no tissue is trapped under the implant. The transconjunctival incision can then be closed with 7-0 Vicryl sutures.