Lateral canthotomy incision for access to lateral orbit
This is Richard Allen at the University of Iowa. This video demonstrates access to the lateral orbit using a lateral canthotomy incision.
Using either a needle tip cautery or a 15 blade, a lateral canthotomy is performed.
An inferior cantholysis and superior cantholysis are then performed with the needle tip cautery or scissors.
During the superior cantholysis, care should be taken not to damage the lacrimal gland in that area.
The lacrimal gland is demonstrated with the cotton tip applicator.
No dissection should be carried under the conjunctiva in this area.
4-0 silk suture is then placed through the lateral upper and lower lid to provide traction during the case.
Blunt dissection can then be performed to the lateral orbital rim.
Malleable and Desmarres retractors are then used to expose the lateral orbital rim.
The periosteum is then incised along the lateral orbital rim with the monopolar cautery.
A Freer periosteal elevator is then used to raise the periosteum off of the lateral orbital rim first extraorbitally then intraorbitally.
The periosteum is gently peeled from the lateral orbital rim, it can then be gently peeled from the lateral orbital wall.
Along this area you will often encounter neurovascular structures penetrating the bone which correspond to the either the zygomaticotemporal neurovascular bundle or zygomaticofacial neurovascular bundle.
The periosteum can then be elevated posteriorly to expose the supraorbital fissure.