File:Orbitozygomatic osteotomy.jpg

The exact location of the cuts from this osteotomy can be a source of confusion, but this can be greatly simplified if the six cuts are thought of as achieving two primary goals: two cuts to remove the superior orbit and four cuts to disconnect the maxillary buttress at its points of attachment. To take advantage of the visualization provided by the orbitozygomatic osteotomy, it is wise to perform an additional craniectomy to eliminate bony obstruction to viewing angles. The superior orbit should be removed with a rongeur as close to the orbital apex and sphenoid wing as possible. Additionally, after use of the additional temporalis retraction made possible by the zygomatic arch removal, the squamous temporal bone should be removed down to the floor of the middle fossa. If necessary, the lesser sphenoid wing should be drilled until no bony elevation exists between the globe and the anterior clinoid process.