Orbital Fractures

For shattered orbits, complex orbits, and/or orbital fractures combined with additional facial fractures, an infraorbital (mid-lid) or subtarsal approach provides direct access to the lower half of the orbital rim and floor with extended exposure without the need for a lateral canthotomy. The key to successful orbital reconstruction is to reestablish pre-traumatic orbital volume through restoration of the critical orbital bulges located postero-inferiorly (antral bulge) and postero-medially (ethmoidal bulge). Infraorbital (mid-lid) or subtarsal incisions allow for wide surgical exposure of the infraorbital rim and floor without the need for a lateral canthotomy when repairing complex orbital fractures and/or in cases of significant periorbital edema. Projection, globe position, and eyelid anatomy should also be evaluated prior to extubation. Shattered orbits, isolated orbital roof fractures, and temporo-frontal-orbital fractures are best managed with wide surgical access via a coronal approach with or without additional approaches.