A medical illustration depicting the surgical procedure for a lateral canthotomy on a right human eye. The diagram shows the periorbital anatomy including the eyebrow, upper and lower eyelids, and the globe with a visible iris and sclera. Two primary surgical instruments are shown: a scalpel performing an initial incision at the lateral canthus (the outer corner of the eye) and iris scissors positioned to lengthen the incision. This procedure is clinically indicated for the emergency management of orbital compartment syndrome to rapidly reduce intraocular pressure and prevent optic nerve ischemia. The educational focus is on the correct anatomical placement of instruments relative to the lateral canthal tendon to achieve ocular decompression.

This clinical intraoperative photograph documents a surgical excision of an orbital mass via a lateral orbitotomy approach on the left eye. The image shows a well-defined, spherical, bulbous mass being mobilized from the intraconal compartment. The tumor displays a smooth, encapsulated surface with a reddish-pink, vascular appearance and areas of pale discoloration. Surgical exposure is achieved through an incision at the lateral canthus (lateral canthotomy), with black traction sutures clearly visible holding the eyelid and orbital margins apart to maintain surgical access. A surgical instrument is seen supporting and elevating the mass from the retrobulbar space, displacing surrounding orbital fat and tissues. This procedure is indicated for the management of retrobulbar tumors, such as orbital schwannomas, which often present with axial proptosis. The photograph provides educational insight into orbital surgical anatomy, the presentation of intraconal tumors, and the technique for lateral orbital decompression and tumor delivery.

This clinical photograph captures an intraoperative view of a surgical procedure involving the lateral orbital rim. A surgical incision has been made through the skin and orbicularis muscle near the lateral canthus, with the surrounding skin marked by purple surgical ink. The surgical field is exposed using a metal retractor to provide visualization of the underlying bone. A surgical drill with a small round burr is being used to create a burr hole (identified as hole n°4) in the lateral orbital rim, just below the level of the lateral canthus. The procedure illustrates a key step in a concentric malar lift or canthopexy, where bone anchoring points are established for suture fixation. The image demonstrates the precise handling of specialized surgical instruments and the subperiosteal exposure required for mid-face rejuvenation and lower eyelid stabilization.

Clinical photographs in frontal (A) and lateral (B) views demonstrating the post-procedural appearance of a lateral canthotomy and inferior cantholysis performed for orbital compartment syndrome. The images show a 57-year-old male with significant proptosis and chemosis of the left eye. In view A, the surgical incision at the lateral canthus is visible, with marked erythema and edema of the periorbital tissues. In view B, the lateral profile emphasizes the degree of globe protrusion (proptosis) and reveals surgical trauma with minor bleeding and tissue disruption at the lateral commissure where the canthal tendons were incised. Blue-gloved hands are seen retracting the upper and lower eyelids to expose the ocular surface and surgical site. This visual documentation serves to illustrate the emergency surgical management required to reduce intraocular pressure and prevent permanent vision loss in cases of retrobulbar pressure buildup.

**Imaging Modality:** Computed Tomography (CT), bone window setting. **Anatomical Region:** Midface and neurocranium, sagittal reformatted view. **Observed Pathology:** Extended orbital floor blowout fracture. The image displays a significant disruption and inferior displacement of the bony orbital floor into the underlying maxillary sinus. There is an associated herniation of orbital soft tissue (extraconal fat and potentially the inferior rectus muscle) into the superior aspect of the maxillary antrum. **Characteristic Visual Features:** - **Osseous Findings:** Comminuted fracture of the floor of the orbit with a large bony defect. - **Soft Tissue Findings:** "Teardrop sign" or trapdoor-type appearance where orbital contents prolapse through the fracture site. - **Secondary Features:** Partial opacification of the maxillary sinus, likely representing hemosinus or displaced soft tissue. The anterior and posterior walls of the maxillary sinus appear grossly intact in this plane, localizing the primary trauma to the orbital interface. **Diagnostic Features:** These findings are characteristic of a high-energy "blowout" mechanism, frequently resulting in globe displacement or entrapment of extraocular muscles. The visualization of the defect in the sagittal plane confirms the anteroposterior extent of the orbital floor involvement.

This diagnostic image is a sagittal non-contrast CT scan of the orbit and midface presented in a bone window. The image demonstrates a subtle blowout fracture of the orbital floor. Key findings include a focal bony defect (indicated by a black arrow) in the orbital floor, representing a 'trapdoor' type fracture. Immediately inferior to this defect, a soft tissue density is visible prolapsing into the superior aspect of the maxillary sinus. A small focus of orbital emphysema (intraorbital air), highlighted by a white arrow, is situated adjacent to this herniated soft tissue. The appearance is highly suggestive of orbital fat and inferior rectus muscle entrapment, which often presents clinically with vertical diplopia and restricted ocular motility. This educational visual emphasizes the importance of identifying subtle radiological signs of orbital trauma, particularly when gross fractures are absent, to prevent permanent muscle ischemia or gaze restriction.

This clinical photograph captures an intraoperative view of an orbital floor reconstruction following a pure blowout fracture. The surgical site is accessed through a transconjunctival approach, with metallic retractors providing exposure of the inferior orbital rim and cavity. Centrally, a titanium mesh implant with a regular perforated grid pattern is visible, precisely contoured to reconstruct the orbital floor boundary. The mesh is rigidly secured to the bone using a micro-screw, visible with a cross-slotted head. The surrounding area shows exposed soft tissue and minor surgical hemorrhage consistent with an active procedure. This image illustrates the surgical management of orbital trauma and the use of internal fixation materials to prevent enophthalmos and muscle entrapment by restoring anatomical volume and structural integrity to the orbit.

This diagnostic image consists of two side-by-side coronal slices from a facial computerized tomography (CT) scan (bone window) demonstrating surgical reconstruction of an orbital blowout fracture. The left orbit (viewer's right) exhibits a fracture involving the inferomedial wall. A hyperdense, radio-opaque implant, identified as a titanium-reinforced porous polyethylene (TR-PPE) plate, is seen positioned along the left medial orbital floor and lower medial wall to reconstruct the defect. A small, focal, high-density point (marked by a white arrow) indicates a single titanium screw used to fixate the plate to the inferior orbital rim. Anatomical landmarks include the bilateral maxillary sinuses, ethmoid air cells, and the nasal cavity. The left orbit shows some soft tissue herniation and postoperative changes compared to the intact right orbit. This image illustrates maxillofacial trauma management and the use of alloplastic materials in orbital floor reconstruction to restore orbital volume and prevent enophthalmos.