Many of the criticisms regarding the constrained operative field often encountered using this approach are overcome by a generous conjunctival incision. A thorough understanding of the relationship between the tarsal plate, lower lid retractors and the orbital septum is also of paramount importance. An incision through the confluence of the conjunctiva, capsu-lopalpebral fascia, and the orbital septum at a level 1 mm below the inferior tarsal margin will lead the surgeon to the space between the orbicularis oculi and the orbital septum without entering the orbital fat. This transcbnjunctival preseptal approach will not disturb the skin, the orbicularis oculi and its facial nerve innervation, and lymphatic drainage, virtually eliminating postoperative lid edema and ectropion. Furthermore, an unobstructed view of the medial orbital wall is made possible by passing posteriorly to the lacrimal apparatus through a nasally advanced incision toward the lacrimal caruncle, a view which is unobtainable through a cutaneous incision.After a thorough investigation and understanding of the detailed anatomy and proper application of the operative technique, one can understand that the logical and anatomically correct approach to the orbit for the treatment of orbitozygomatic fracture is the transconjunctival approach.
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