Inadequate treatment of complex midfacial fractures involving the orbi
t and zygomatic arch can result in important functional and aesthetic
deformity. Accurate repair of fractures at the zygomatic arch and orbi
tal floor has traditionally necessitated coronal scalp and lower eyeli
d incisions respectively. Complications such as facial nerve injury, a
lopecia, external scarring, ectropion, and eyelid edema have been asso
ciated with these traditionally open surgical techniques. We report an
endoscopic-assisted technique of open reduction and rigid fixation of
a complex midfacial fracture. The endoscopic-assisted technique facil
itated the anatomic repair of associated zygomatic arch and orbital fl
oor fractures. The technique minimized ocular globe manipulation and e
liminated the need for coronal scalp and lower eyelid incisions.