Resident Manual of Trauma to the Face, Head and Neck

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 3.23 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.

Figure 3.26 (left) Completion of medial orbital repair and release of orbital contents.

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