The naso-orbital complex and medial orbit may need to be exposed for trauma or other pathology. Direct medial canthus incisionsMedial canthus incision" are traditionally avoided by non-oculofacial plastic surgeons, owing to unfamiliarity with the anatomy and concern for a conspicuous facial scar. With good technique and preservation of the underlying tendinous and lacrimal structures, direct medial canthus incisional approaches offer excellent access to the naso-orbito-ethmoid complex without canthal dystopia or a problematic scar. In this chapter, the authors detail medial orbitotomyMedial orbitotomy" approaches for trauma and other indications.