Surgical approaches to the orbit.

After the appropriate workup, the size, location, and consistency of an orbital mass will dictate the surgical approach chosen. Masses in the muscle cone area or in the temporal portion of the orbit are most easily approached by the lateral orbitotomy. For lacrimal gland tumors a superior extension of the lateral orbitotomy will expose the lacrimal fossa area. The superior medial subperiosteal approach is indicated for masses in the superior medial orbit. For the more difficult area between the medial rectus and optic nerve, the combination lateral-medial orbitotomy through the medial fornix will expose the medial retrobulbar area. To reduce postoperative morbidity, emphasis is placed on adequate exposure, careful manipulation of tissues, and meticulous hemostasis.