Step 6 Periosteal Incision

With retraction of the orbital contents and the lower lid, using suitable retractors, a scalpel is used to icise the periorbita, taking care to stay lateral to the lacrimal sac (Fig. 3-11). The incision through the periorbita is just posterior to the orbital rim when the retroseptal approach is used.

Figure 3 11 Incision through periosteum. To facilitate this maneuver, a traction suture is placed through the cut end of the conjunctiva to retract the tissue and maintain the position of the corneal shield. Small retractors are placed so that the lower lid is retracted to the level of the anterior surface of the infraorbital rim. A broad retractor is placed just posterior to the infraorbital rim, confinig the orbital fat. The intervening tissue along the infraorbital rim is the periosteum. The incision is made through the periosteum just posterior to the infraorbital rim.

Figure 3 11 Incision through periosteum. To facilitate this maneuver, a traction suture is placed through the cut end of the conjunctiva to retract the tissue and maintain the position of the corneal shield. Small retractors are placed so that the lower lid is retracted to the level of the anterior surface of the infraorbital rim. A broad retractor is placed just posterior to the infraorbital rim, confinig the orbital fat. The intervening tissue along the infraorbital rim is the periosteum. The incision is made through the periosteum just posterior to the infraorbital rim.

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