A re-evaluation of the transconjunctival approach to orbital tumors

Abstract

The conjunctival approach for the removal of deep orbital tumors is generally regarded as a less satisfactory access, because of a narrower exposure of the operative field. In the last five years, the authors performed 29 transconjunctival excisions of orbital tumors; 22 cases were intraconal or located posteriorly to the equator of the globe. The complication rate is very low (only one case of 1.5 mm ptosis) and the results are quite satisfactory (all tumors completely removed).

After a careful pre-operative evaluation of CT and/or mri scans, the surgical technique is based upon a conjunctival fornix approach, followed by blunt dissection and tumor excision by application of a cryoprobe or a blunt forceps. A lateral canthotomy may be needed.

In the authors' opinion, the indications of transconjunctival orbitotomy are represented by well delimited masses (suspected cavernous hemangiomas, solitary neurofibromas, schwannomas, dermoids), especially if anterior or medial, with the exception of lacrimal gland epithelial tumors and deep, lateral tumors. The advantages of conjunctival approach are represented by a better cosmetic outcome and a full respect of periosteum and anterior orbital septa.

Key Words:

• Orbital surgery
• orbital tumors
• conjunctival approach