**4.3. Periorbital approaches**

**Figure 14.** Intraoral approach to expose the Le Fort I fracture line.

66 Trauma Surgery

**Figure 15.** Coronal approach for management of Le Fort III fracture (courtesy of Dr. Fereydoun Pourdanesh).

Four kinds of periorbital approaches are represented in the literature for reconstruction of orbital fractures and Le Fort II fracture. The incisions on the lower lid are classified into three types based on the distance from the gray line (**Figure 17**). The periorbital approach is called subciliary incision when this distance is about 2–3 mm. When this distance is almost 3–4 mm to the gray line the incision is known as mid-lower lid or subtarsal approach. The dissection of these two techniques is in three fashions. The best dissection technique is to start a few millimeters subcutaneously followed by orbicularis oculi muscle dissection. Skin only or pre-orbicularis oculi muscle incision is not advocated by authors due to high possibility of ectropion rate. The third incision is called skin-muscle flap which involves both skin and orbicularis oculi muscle.

Another popular periorbital approach because of its invisible scar is the transconjunctival technique (**Figure 18**). The incision is made parallel to the gray line through the conjunctive. This approach is divided into preseptal and retroseptal techniques based on the dissection plane. Lateral canthotomy and inferior cantholysis are used in some cases when the surgeon needs more access to the orbit.

**Figure 16.** Lateral brow approach.

key step of deciding the treatment plan. The surgeon should have enough knowledge of facial anatomy and physiology to be able to reconstruct the fractured segments. Deformity following facial trauma is hard to repair on the second surgery. So the importance of managing almost all problems of mid-face fractures in the first surgery is pretty clear to all traumatologists.

Maxillofacial Fractures: From Diagnosis to Treatment http://dx.doi.org/10.5772/intechopen.76166 69

The authors declare that they have no conflict of interest. The photos not referenced in the text

Department of Oral and Maxillofacial Surgery, School of Dentistry, Semnan University of

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**Conflict of interest**

belong to the author.

**Author details**

**References**

Mohammad Esmaeelinejad

Medical Sciences, Semnan, Iran

Medical Journal. 2017;**26**:218

Facial Surgery. 2004;**32**:308-313

Craniofacial Surgery. 2002;**13**:726-737; discussion 38

Journal of Cranio-Maxillofacial Trauma. 1998;**4**:38-43

2013;**16**:199-203

Address all correspondence to: esmaeelnejad@gmail.com

**Figure 17.** Periorbital incisions. Subciliary (A), subtarsal (B), and infraorbital (C) approaches are shown in this picture.

**Figure 18.** Transconjunctival approach is used to expose the orbital floor fracture.
