[Basedow exophthalmos: lipectomy or orbital expansion?].

Graves' disease is due to mismatching of the orbit and its contents. Primary muscular hypertrophy is often accompanied increased intraorbital pressure due to obstruction of the venolymphatic drainage at the orbital apex. In moist cases, the fat undergoes minimal volumetric and structural changes. Among the numerous techniques proposed for orbital decompression the solution which allows the greatest orbitoperiosteal expansion while preserving the integrity of the orbital fat is valgus displacement of the malar bone combined with resection of the lateral wall and recession of the inferior and medial orbital walls. This technique, which can be adapted to the severity of each case, is performed via a infraciliary transpalpebral facial incision. It is easier to perform than via a coronal incision. It should be preferred to trans-sinus techniques which have a limited and dangerous action (considerable incidence of postoperative diplopia) and decompression lipectomy, which is difficult to perform, with a light risk and, furthermore, does not take into account the fundamental physiological role of the orbital fat nor the essentially muscular pathogenesis of exophthalmos.