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  • 1. Introduction
  • 2. Surgical Approach
  • 3. Transconjunctival Approach to the Orbital Floor and Removal of Infected Implant
  • 4. Exposure of Entire Orbital Floor Defect and Preparation for New Implant
  • 5. Placement of New Orbital Floor Implant
  • 6. Examine and Consider Opening Up Maxillary Sinus
  • 7. Closure
  • 8. Post-op Remarks
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Neuronavigation and Endoscopy as Adjunctive Tools in Orbital Floor Implant Revision: Surgical Management of Infected, Misplaced Orbital Floor Implant with Chronic Eyelid Fistula and Sinusitis


Derek Sheen, MD1; Cheryl Yu, MD2; Sarah Debs, MD2; Katherine M. Yu, MD2; Alyssa N. Calder, MD2; Kevin J. Quinn, MD3; Dimitrios Sismanis, MD4; Thomas Lee, MD, FACS2
1University of Texas Southwestern Medical Center
2Virginia Commonwealth University Medical Center
3Mass Eye and Ear/Harvard Medical School
4Virginia Oculofacial Surgeons

Procedure Outline

  1. Inject 1% Lidocaine with 1:100,000 Epinephrine
  1. Start with Lateral Canthotomy
  2. Create Transconjunctival Incision While Preserving Tarsus
  1. Expose Stable Remaining Medial Orbital Wall
  2. Estimate Length and Shape of Implant
  1. Use Malleables to Retract Orbital Content Superiorly; Prepare for Implant Placement
  2. For Complex Revision Cases, Use Neuronavigation to Check for Implant Positioning
  3. Secure Implant with Screws
  1. Address Eyelid Fistula Site
  2. Close Transconjunctival Incision
  3. Close Lateral Canthotomy
  4. Resuspend Lateral Canthus