In line with increase of facial trauma mostly from assault, fall-down, or high-energy impact, the frequency of orbital fracture has been increased gradually. The most frequent sites of orbital fracture are medial wall and orbital floor. To reduce or reconstruct these sites, there are lots of access routes such as subcilliary incision, mid-lower lid incision, infraorbital rim incision, and transconjunctival incision. Meanwhile, in cases of fracture of the upper half of the orbit containing supero-medial wall or roof, these approaches have limitation to expose the fracture site enough, so that the bicoronal incision is required. The bicoronal approach provides the best exposure without interference of the medial canthal tendon. However, conspicuous bicoronal incision scar can be shown easily in bald patients after operation, and even in non-bald patients the bicoronal incision can be accompanied by possible risk factors such as alopecia, loss of scalp sensation, and damage of frontal branch of facial nerve postoperatively. To avoid these problems, we authors performed transpalpebral approach, instead of bicoroal approach to expose fracture sites of the upper half of the orbit. We executed transpalpebral and transconjunctival approach on 21 orbits of 19 patients who consulted plastic surgeons to reduce or reconstruct fractures of the upper half of the orbit including enophthalmos. There are no significant complications except hypesthesia or anesthesia on ipsilateral forehead. But these sensory changes are all temporary and persist for 9 months in maximum. No permanent sensory loss in the forehead noted. The external scar on the supratarsal fold of the upper lid was invisible, with no scar deformities or contractures in any patients. We propose that the transpalpebral approach can be substitution for the bicoronal approach especially in the fractures of the supero-medial wall and roof of the orbit.
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