[A modified surgical approach to the orbits]

A major precondition for microsurgical removal of an orbital tumor is adequate topographic preparation of the structures involved. Cosmetic aspects also have to be considered. In this regard, the modified surgical approach presented here is superior to the familiar techniques of lateral orbitotomy. The surgical steps are as follows: hemicoronal incision of the skin starting from the superior end of the external ear, extending into the hairy temporo-frontal region, and ending close in front of the hair line. This incision is performed through the periosteum down to the bone, so that the forehead skin flap can be exposed to give complete exposure of the temporal muscle and the entire bony borders of the orbit. Following the osteoplastic removal of the lateral orbital rim and wall, the periorbita is opened and the intraorbital tumor can be removed microsurgically all along the superior, lateral, and inferior regions of the orbit and the muscle cone even in the orbital apex. The postoperative functional and cosmetic results are good.