A, Structures superficial to the lateral orbital wall include the branches of the facial nerve to the orbicularis oculi and frontalis muscles, which cross the midportion of the zygomatic arch; the anterior branch of the superficial temporal artery; and the temporalis muscle, which passes medial to the zygomatic arch to insert on the coronoid process of the mandible. B, The curved skin incision begins in front of the ear, extends forward along the upper edge of the zygoma, and turns upward along the lateral rim of the orbit. The superficial temporal artery and vein are exposed. A zygomaticotemporal nerve branch of the maxillary nerve passes through the lateral orbital wall to convey sensation to the temple. Care is required to preserve the branches of the facial nerve to the orbicularis oculi and frontalis muscles and, if transected, reapproximation should be attempted at the end of the operation. C, The lateral orbital rim formed by the frontal process of the zygomatic bone and the zygomatic process of the frontal bone has been exposed. The temporalis muscle has been elevated from the lateral orbital wall. D, The part of the lateral wall of the orbit formed by the frontal and zygomatic bones and the adjacent part of the sphenoid wings has been elevated as a small bone flap to expose the periorbita of the anterior two-thirds of the orbital wall. The lacrimal artery and nerve course in the orbital fat above the lateral rectus muscle. The orbital part of the lacrimal gland is exposed outside the orbital fat. The lateral orbital rim, which has been removed in a single piece, is replaced after removing the orbital lesion. (Images courtesy of AL Rhoton, Jr.)