• Archives of Plastic Surgery
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• v.34 no.6
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• pp.724-728
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• 2007

Purpose: The objective of this study is to prevent postoperative lower eyelid retraction and scleral show. There are several approaches for orbital rim reconstruction. But these techniques are sometimes difficult to perform, and have some merits and faults. Maybe most common unwanted and unpleasant result that we have experienced by subciliary incision preseptal approach is the lower eyelid retraction and the scleral show. Therefore, I want to find out the causes and the solutions for such complication. We must know the mechanics for those unpleasant result first of all. Methods: We conducted a comparison of postoperative photographs between retroseptal approach group and preseptal approach group, both with subciliary incision. In experimental retroseptal group, incision was applied at subciliary region. After elevating skin flap to preserve pretarsal muscle, not with muscle flap elevation, but direct oblique incision through the muscle, retroseptal dissection was applied to the ROOF and the septum. Fixating fracture line, periosteal and septal repair was followed by skin repair. The light compressive dressings and protection were kept in place for 7 days. The effectiveness of this operative method was made comparison with control group which the preseptal approach was applied to, by postoperative 2nd week and 2nd month. Results: Author's technique had been used in 20 patients and control group was composed of 50 patients over 19months period. There were better results in experimental group than in control group and all of experimental group had no complaint about the lower eyelid retraction and the scleral show. Conclusion: It must be known about the reason of the lower eyelid retraction and the scleral show induced by subciliary and preseptal approach. Mechanically it can be easily proved. And the solution maybe will be easier if we get more information about the mechanics. I recommend the retroseptal subciliary approach

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.552-556
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• 2006

Purpose: As the use of computed tomographic scanning spread, the diagnosis of blow-out fractures of the medial orbital wall increased. Conventionally, the surgery of blow-out fractures in medial orbital wall was performed by various approaches with external incision or endoscopic approach. Although the field of orbital surgery has progressed significantly during the last decade, accurate realignment and replacement of component is difficult due to lack of visualization of the fracture site, blind dissection of the orbital wall, and difficulty in insertion of implant. In order to overcome these shortcomings, we explored the use of endoscopic transnasal approach together with subciliary approach. Methods: The entrapped periorbital tissues in the ethmoid sinus were completely reduced endoscopically, and the bone defect of medial orbital wall was reconstructed with $Medpor^{(R)}$ insertion via subciliary approach. This technique was applied to 13 patients who had medial orbital wall fracture. Results: The patients were followed-up for 3 to 24 months with an average of 9 months. The postoperative courses were satisfactory in all cases. Conclusion: The conjunction of endoscopic transnasal and subciliary approach technique seems to produce good results in medial orbital wall fracture.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.465-468
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• 2006

Purpose: Subciliary approaches to orbitozygomatic fractures have high incidence of complications such as scleral show and ectropion. Abnormal rearrangement of eyelid flaps may be a very important factor to induce abnormal cicatrical and consequent contracture. To prevent this problem, we used temporary lower eyelid suspension. Methods: A total of two hundred five patients were investigated for lower eyelid complication of orbitozygomatic fractures that underwent reconstruction with subciliary approach. The lower eyelid margin was pulled up toward the forehead using lower eyelid suspension suture to stretch the lower lid flaps. The lid suspension was maintained for one day after surgery. Results: The complications of the lower eyelid were in 15 cases(7.3%); seven cases(3.4%) of visible depressed scar, three cases(1.4%) of scleral show, two cases(1%) of ectropion, two cases(1%) of conjunctival swelling and one case(0.5%) of hematoma. Conclusions: The lower eyelid suspension seems to allow adhering lid flap in proper anatomical position and in the status of the maximal stretch and consequently preventing the severe complications such as scleral show and ectropion caused by scar contraction after subciliary approach.

• Archives of Craniofacial Surgery
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• v.17 no.2
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• pp.63-67
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• 2016

Background: The subciliary approach is commonly used for reconstruction of orbital wall or zygomaticomaxillary fractures. However, this approach is associated with postoperative complications, especially lower eyelid malposition. We report the experience of managing postoperative lower eyelid malposition with triamcinolone acetonide. Methods: A retrospective review was performed for all traumatic facial fractures requiring surgery via the subciliary approach at Chosun University Hospital in 2014. For each patient meeting inclusion criteria, the medical chart was reviewed for demographic information and postoperative course, including the presence of postoperative eyelid malposition or scleral show. Results: The review identified 189 cases in which the subciliary approach was used, and postoperative lower eyelid malposition was found in 7 cases (3.7%). For these 7 patients, the mean therapeutic period (interval to correction of the malposition) was 10.5 weeks (range, 8 to 14 weeks). On average, patients received 3 injections of triamcinolone. In all cases, degrees of the malposition were improved, and none of the patients required an operative intervention to correct the malposition. Conclusion: Triamcinolone injection is an appropriate treatment modality for lower eyelid malposition after subciliary approach. Treatment duration is relatively short, requiring fewer than 4 outpatient clinic visits, with relatively earlier recovery compared to conservative "wait-and-see" management.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.261-266
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• 1989

This study was undertaken to compare those 4 most commonly used incisions for exposure of fractures of the infraorbital rim and the orbital floor. The patient's age ranged from 19 to 67 years, the majority being in the 2nd decade. There were 17males and 1 female. Three orbital rim, 5 lower eyelid, 7 subciliary and 3 combined conjunctival-lateral canthotomy incisions were reviewed. Following points were the summury of author's experience. 1. The average scar following any of four incisions is barely noticeable. 2. Adequate fracture exposure was achieved with lower eyelid, orbital rim, subciliary and combined conjunctival-lateral canthotomy incisions. 3. One transient ectropion following subciliary incision occurred in 29-years old man with prolonged postoperative eyelid edema.

• Archives of Craniofacial Surgery
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• v.10 no.2
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• pp.86-90
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• 2009

Purpose: Inferior blow-out fracture is the common facial fracture. Unsatisfactory functional and aesthetic outcomes are frequent when it is treated inappropriately. If fractures are extended and reach the posterior end of orbital floor, enophthalmos frequently followed as complication. The purpose of this study was to evaluate reduction technique of extensive inferior blow-out fracture with ballooning of foley catheter through endoscopic transnasal approach and implantation of $Medpor^{(R)}$ through subciliary approach. Methods: A retrospective study was performed on 14 patients with extensive inferior blow-out fracture who underwent ballooning of foley catheter through endoscopic transnasal approach with implantation of $Medpor^{(R)}$ through subciliary approach. Patients were operated from May 2005 to November 2007. Data for 14 patients were acquired from patient's charts. Preoperative and postoperative data for enophthalmos, diplopia, limitation of extraocular motion were reviewed. Preoperative and postoperative CT scan were also checked. The patients were followed up from 4 to 18 months. Results: The enophthalmos was corrected in all patients. Among 7 patients with diplopia preoperatively, diplopia was resolved in three patients postoperatively. The diplopia persisted in four patients and two of them also had limitation of extraocular motion postoperatively. The limitation of extraocular motion occurred in seven patients preoperatively. But five patients recovered after operation immediately. These symptoms were resolved about three months after the operation. Conclusion: The ballooning of foley catheter through endoscopic transnasal approach with implantation of $Medpor^{(R)}$ through subciliary approach can be considered one of the appropriate technique for extensive inferior blowout fracture.

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.250-257
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• 2007

Purpose: Aging changes of midface include drooping of lower lid, wrinkles of malar area, orbitomalar groove and deepening of nasolabial fold from drooping of malar fat pad. Improvement of lower lid can be achieved through lower blepharoplasty, but improvement of cheek can not be gained. Superficial subciliary cheek lift(by Moelleken, 1996) is a method that lifts malar fat pad through extended subciliary incision. We obtained simultaneous improvement of lower lid, malar wrinkles and orbitomalar groove with modification of this technique. Methods: From December 2003 to January 2006, we performed this method on 21 patients among volunteers for lower blepharoplasty who wanted to correct orbitomalar groove and malar wrinkles. Under local anesthesia, lateral extension of subciliary incision is done 1cm from the lateral orbital rim. Skin-muscle flap is elevated, and dealing of orbital fat and septum is the same as with ordinary lower blepharoplasty. After downward subcutaneous dissection through extended incision, exposing the upper 1/3 level of malar fat pad, superolateral fixation is done to superior deep temporal fascia. Excision of the upper part of fat pad is performed, if needed. After excision of overlapped skin-muscle flap, skin closure is done. Results: We obtained satisfactory results with this simple method for improvement of orbitomalar groove and malar wrinkles among patients for lower blepharoplasty. During a follow-up period of 5 months on the average, no revision was performed. Conclusion: Under local anesthesia, lower blepharoplasty and improvement of orbitomalar groove and malar wrinkles can be achieved at the same time. It is good for patients who do not want conventional midface-lifting. But surgeons should select patients and perform cautiously for it may leave a scar of the extended incision that require over 2 months for maturation and it is insufficient for improvement of nasolabial fold compared to conventional mid face-lifts.

• Archives of Craniofacial Surgery
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• v.13 no.2
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• pp.99-103
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• 2012

Purpose: Many surgical methods for reconstruction of orbital floor fracture have been reported, which include subciliary approach, transconjunctival approach, transantral and transnasal endoscopic approach, etc. The purpose of this study is to demonstrate a surgical technique and analyze the results of transnasal endoscopic approach with Foley catheter ballooning without implantation of artificial surgical material through subciliary approach. Methods: Between February 2007 and November 2010, 29 orbital floor fracture patients, who had no herniated muscles through bone fragments, were treated through transnasal endoscopic approach with Foley catheter ballooning. Under the endoscopic view, the operator identified the opening of maxillary sinus. After widening of the opening using forceps, the operator reduced the fragmented bone with curved suction tip. Thereafter, 18-Fr Foley catheter was inserted. Four weeks after the operation, the catheter was removed. Results: Preoperatively, 6 patients had diplopias, 4 patients had limitations of extraocular motions and 3 patients had enophthalmos. After removal of the Foley catheter 4 weeks after the operation, 2 patients had diplopias, 1 patient had a limitation of extraocular motion, 1 patient has an enophthalmos and 1 patient had numbness on the cheek. These symptoms were resolved about 6 months after the surgery. Conclusion: The operative technique of Foley catheter ballooning through transnasal endoscopic approach without implantation of the artificial surgical material through subciliary approach can be considered one of the appropriate techniques for orbital floor fracture.

• Archives of Craniofacial Surgery
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• v.20 no.2
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• pp.101-108
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• 2019

Background: To date, a variety of surgical approaches have been used to reconstruct the medial orbital wall fracture. Still however, there is still a controversy as to their applicability because of postoperative scars, injury of anatomical structures and limited visual fields. The purpose of this study was to introduce a useful additional medial subbrow approach for better reduction and securement more accurate implant pocket of medial orbital wall fracture with the subciliary technique. Methods: We had performed our technique for a total of 14 patients with medial orbital wall fracture at our medical institution between January 2016 and July 2017. All fractures were operated through subciliary technique combined with the additional medial subbrow approach. They underwent subciliary approach accompanied by medial wall dissection using a Louisville elevator through the slit incision of the medial subbrow procedure. This facilitated visualization of the medial wall fracture site and helped to ensure a more accurate pocket for implant insertion. Results: Postoperative outcomes showed sufficient coverage without displacement. Twelve cases of preoperative diplopia improved to two cases of postoperative diplopia. More than 2 mm enophthalmos was 14 cases preoperatively, improving to 0 case postoperatively. Without damage such as major vessels or extraocular muscles, enophthalmos was corrected and there was no restriction of eyeball motion. Conclusion: Our ancillary procedure was useful in dissecting the medial wall, and it was a safe method as to cause no significant complications in our clinical series. Also, there is an only nonvisible postoperative scar. Therefore, it is a recommendable surgical modality for medial orbital wall fracture.

• Archives of Craniofacial Surgery
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• v.19 no.3
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• pp.231-234
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• 2018

A schwannoma is a benign tumor that develops from Schwann cells. It is known to occur more frequently in women than men, and about one third of schwannoma cases occur in the head and neck area. It is also known to originate mainly in the auditory nerve. However, it is rarely associated with the trigeminal nerve, and especially, schwannomas related to the infraorbital nerve are very rare. we report a rare case of a schwannoma involving the infraorbital branch of the trigeminal nerve in a 45-year old male adult. The patient underwent physical examination and magnetic resonance imaging. The mass was approached through subciliary approach that is familiar to the plastic surgeon and completely resected. Histopathological findings showed pointed to a benign schwannoma. Infraorbital nerve schwannoma is difficult to distinguish from other diseases by means of clinical symptoms, physical findings, or imaging. In spite of its rarity, infraorbital nerve schwannoma may be considered a possible diagnosis in the case of mass on cheek. Assessment by computed tomography or magnetic resonance imaging is necessary for proper diagnosis. About the surgical approach, excision through the subciliary approach should be considered rather than the direct transfacial approach in view of stability, cosmetic effects, and familiarity.