Medial orbital wall fractures are less common than orbital floor fractures. They rarely occur as an isolated entity, but are found in association with orbital floor fractures or as a component of nasoorbitoethmoidal fractures.
According to the type of injury exposure of the medial orbital wall can be accomplished either via a limited small incision or an extended surgical approach (ie, the pre-/transcaruncular approach may be used instead of a coronal approach).
Both approaches have their specific advantages and pitfalls. The pre-/transcaruncular approach allows adequate access to the medial orbital wall and can be extended using a transconjunctival incision to expose the orbital floor. The attachments of the medial canthal apparatus and the lacrimal sac restrict the placement of retractors for the exposure of the anterior and superior portion of the medial wall.
If indicated a lateral canthotomy and inferolateral cantholysis can also be used to extend the approach to the lateral orbital wall.
This combination of the pre-/transcaruncular, the transconjunctival, and the lateral canthotomy provides access to three orbital walls in the medio inferolateral circumference of the orbital cavity through a single incision.