Q: I would like to know more about the transconjunctival approach referring to orbital rim augmentation with medpor implants and subperiostal midface lifts. Because you are both a plastic surgeon and an oral an maxillofacial surgeon I´am sure you are very familiar with this kind of approach. Once I have read that the infection rate of medpor implants placed through an intraoral approach is a little bit higher, because the mouth can´t be completely disinfected. Is it the same with the transconjunctival approach or is the mucosa in the lower eyelid an area in the face that is usually very clean due to its special purpose? What are the common risks of a tranconjunctival approach? Is there any chance of getting blind after such an operation? If performed right, has the transconjunctival approach any risk of ectropion or entropion or an increase of scleral show? Thank you in advance for your reply.
A: Unfortunately, you have been misinformed about placing any type of orbital rim implant through a transconjunctival approach, regardless of the material type. That is simply not physically possible given the size of the implant and the very size of this inner eyelid incision. All orbital rim implants have to be done through an external or subciliary lowere eyelid incision. This is the only way to insert them and have them properly secured into place.
You are correct about the higher rate of infections with porous implants like Medpor when placed through an inside the mouth or mucosal incision. That has been my experience as well.
Dr. Barry Eppley