Direct local approach through a W-shaped incision in moderate or severe blowout fractures of the medial orbital wall

For moderate or severe blowout fractures of the medial orbital wall, the goals of treatment are complete reduction of the herniated soft tissue and anatomic reconstruction of the wail without surgical complications. Various surgical approaches have been used, depending on the anatomic location and the extent of medial wall fracture. However, there is no consistent method to achieve the treatment goals with minimal morbidity because of one or more problems of limitation of entire medial wall exposure, limitation of large implant or bone graft insertion, surgical damage of important periorbital or intraorbital structures, or postoperative scar deformities. In this study, a direct local approach through a 3-cm, W-shaped incision on the superior medial orbital area was used as a consistent method to reconstruct medial orbital blowout fractures. The angle of the W-limbs is 110 to 120 degrees. Four limbs of the W were placed parallel or oblique to the relaxed skin tension lines. This technique was applied to 39 orbits of 37 patients with moderate or severe blowout fractures of the medial orbital wall. This approach provided exposure of the entire medial orbital wall, adequate placement of a large implant, short operation time within 2 hours, and no damage of important internal structures. Postoperative computed tomographic scans showed complete reduction of the herniated orbital tissues and anatomic reconstruction of the medial orbital wall without complication related to the surgical approach in all cases. During the follow-up period of 6 to 14 months, excellent functional and cosmetic results were observed with an inconspicuous scar without secondary scar deformities. Therefore, a direct local approach through a W-shaped incision on the superior medial orbit may be a consistent method to gain the surgical goal in treatment of moderate or severe blowout fractures of the medial orbital wall.