These facts are never mentioned in the article by the authors. However, for these and other reasons, during the era of superior decompression surgery, 2-4 attempts to enhance the superior approach were made by also including a lateral decompression. Unmentioned but pertinent remain the factors discussed in the preceding paragraphs. The orbital door jamb is a part of all lateral decompression surgery. However, avoidance of the thick part of the wall to avoid exposing the middle fossa and the temporal lobe was the rule.
Concern is warranted if the thick part of the wall is removed.
Some surgeons 8 advocated rotating the thin wall outward to provide the fat a defined space in the orbital expansion. With this method there were attempts to expand the space by expanding the decompression superiorly or inferiorly as part of a larger procedure. The basin of the inferior orbital fissure is likewise a useful area for expansion, but thinning this bone to only a thin rim along the lateral orbital rim and face of the zygoma may seriously weaken a central aspect of the facial structure, namely the malar complex, and give rise to potential fractures that would normally be rare with an intact malar complex area. This identifies their work as a new hybrid of bony decompression and fat removal for orbital decompression. In the face of a general abandonment of the lateral orbital approach as the primary decompression procedure, the authors now seek to resurrect it.