Step 6 Periosteal Incision

The skin-muscle flap is retracted until the area of interest is exposed. The periosteum is divided 2 to 3 mm posterior to the orbital rim with a scalpel (Fig. 5-4).

Deep Temporalis Fascia Incision Fascia

Figure 5 4 Incision through periosteum along lateral orbital rim and subperiosteal dissection into lacrimal fossa. To facilitate retraction of the skin/muscle flap, it can be widely undermined laterally and retracted with small retractors. Because of the concavity just behind the orbital rim in this area, the periosteal elevator is oriented laterally as dissection proceeds posteriorly.

Figure 5 4 Incision through periosteum along lateral orbital rim and subperiosteal dissection into lacrimal fossa. To facilitate retraction of the skin/muscle flap, it can be widely undermined laterally and retracted with small retractors. Because of the concavity just behind the orbital rim in this area, the periosteal elevator is oriented laterally as dissection proceeds posteriorly.

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