Whichever incision is chosen, the dissection should continue in a plane between the orbicularis oculi muscle and the orbital septum until the infraorbital rim is reached, where an incision is made about 5 mm below this rim. The overlying periosteum is elevated posteriorly freeing up the trapped soft tissues. For medial wall fractures, an incision is made midway between the caruncle and the nasal dorsum. Dissection should stay anterior to the posterior ethmoid artery. The bony fragments should be elevated if possible.
Some defects are small enough that all that is needed is reduction of the soft tissues.
Most, however, require reinforcement of the orbital wall defect with an alloplastic mesh implant. Barry M. Zide and Glenn W. Jelks. Surgical Anatomy of the Orbit. Oral and maxillofacial trauma. Management of Blowout fractures.