Transcutaneous superior orbitotomy. A, A superior transcutaneous eyelid crease is created, dissecting through skin, orbicularis and subcutaneous tissues. B, The dissection may be directed trans-septal, or as in this case, to the tissues immediately superficial to the periosteum without violating the septum. C, The plane of the periosteum is marked with blue dots, after dissecting through superficial soft tissue of the brow area. D, The periosteum has been opened with electrocautery, and the subperiosteal plane is attained with a freer elevator. E, The subperiosteal potential space is exposed. F, In this case, the periorbita is opened to obtain a lesion (MALT lymphoma) immediately deep to the periorbita within orbital fat. This is also an excellent approach to reach the lacrimal gland when a deep biopsy is necessary.