The key to successful reconstruction of the medial orbital wall is adequate visualization of the defect and precise contouring of the implant.
Management of medial orbital wall fractures has benefited from recent surgical (extension of transconjunctival incision medially) and technological developments and from technological advances such as navigation. However, it is up to the surgeon to gain the best visualization of the defect.
Exposure of medial orbital wall fractures can be very challenging. Other than techniques using transnasal endoscopic approaches, various lower eyelid approaches are required (transcutaneous, or transconjunctival) for exposure of the medial orbital wall.
In more complex panfacial fractures, and the nasoethmoid complex is involved, the medial orbital wall can also be reached through the coronal approach.
The challenge is to use the appropriate approach providing ideal visualization of the fractures, access for insertion of material, and an optimal esthetic result. The authors recommend maintaining a safety margin of 1 cm anterior from the optic canal during dissection and reconstruction.
Note: In any midfacial or orbital fracture treatment, pay particular attention not to harm the cornea or conjunctiva chemically, mechanically, or by heat. Care should be taken to prevent injury beginning with surgical preparation (surgical scrub) and throughout the entire surgical procedure. Special corneal protectors, ointments, or temporary eyelid suture techniques should be considered to prevent corneal or conjunctival irritations.