Under general anesthesia, a combined intraoral and transconjunctival lower eyelid incisions were used to approach the fracture. The cheek bone was disimpacted and rotated back upward into anatomic position and secured into place with multiple 1.5mm plates and screws. Any loose bone fragments were attached to the metal mesh. A fine metal mesh was used to rebuild the lower orbital rim. The large infraorbital nerve was entrapped in the fracture but not severed. Both mucosal incisions were closed with dissolveable sutures.