Surgical anatomic concepts and pearls to enhance dissection and navigation in the orbit.

1. Clinical Pearls – Surgical
Anatomy of the Orbit
Mark Engelstad DDS, MD, MHI
OHSU - Portland, OR
Nov 3, 2017

4. • Anterior Lamella
• Middle Lamella
• Posterior Lamella

5. Frontalis
Orbital portion of
Orbicularis
Pretarsal
Orbicularis
Preseptal
Orbicularis
Anterior Lamella

6. Orbital septum Middle
Lamella

8. Lateral Medial
Lateral canthal
tendon
Levator palpabrae
superioris
Levator
aponeurosis
Capsulopalpebral
fascia

9. Arcus

11. Medial canthal
anatomy

19. Inferior Oblique
insertion

20. Whitnall’s Tubercle

24. Optic nerve
Frontal nerve
Trochlear nerve
Sup branch of
Oculomotor
nerve
Abducens nerve
Inf branch of
Oculomotor
nerve
Superior Orbital Fissure

26. Symmetry

27. Symmetry

34. Area of Fracture
Volume of Herniation

54. • “Key” area -Hammer
• “Confluence” of the orbit -
Evans
• Posterior-medial bulge
• Deep orbit

55. “key” area (B. Hammer)

64. Post-traumatic
Orbital
Reconstruction:
Anatomical
Landmarks and the
concept of the Deep
Orbit.
BT Evans, BJOMS Nov
2006

68. Infraorbital Fissure contents

71. Orbital Plate of Greater Wing of Sphenoid
Anterior 1/3

73. Palatine Bone

78. • Volume of Herniation
• Follow the InfraOrbital nerve
• Notice the shape of the Inf. Rectus
• Reduce MCT : superior & posterior
vector of pull
• The palatine bone is our “posterior
ledge”
• The orbital floor is not flat like a floor

79. mark.engelstad@gmail.com