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Figure 3.23

Medial canthal incisions to approach medial

orbital fracture—double Z-plasty on the right,

and gull-wing incision on the left.

Figure 3.24

Exposure of the left medial orbital fracture

for repair and release of entrapped orbital

tissue, as viewed from patient’s right side.

Figure 3.25

Traction on the medial rectus muscle to

release entrapment in medial orbital fracture.

ethmoid arteries (Figures 3.23 and 3.24). The exposure is sufficient to

reduce medial orbit entrapments and fixate the intercanthal distance to

the proper width (Figures 3.25 and 3.26). The incision can be extended

superiorly (as with a Lynch incision) to expose the region of the

trochlear slip, if that structure needs repair, or can be reattached to the

superior-medial orbital wall. If the incision is extended much beyond 1

centimeter, it is wise to incorporate a small Z-plasty to reduce the risk

of web formation in this concave anatomic area.

Figure 3.26

(left)

Completion of medial orbital repair

and release of orbital contents.