The rationale for transanthral approach in orbital floor fractures was formulated according to authors' treatment experience. The study included 525 patients aged 13 to 72 years with orbital floor fractures history (278 with posttraumatic deformities and 247 with recent fractures). Reposition and internal fixation was performed via transanthral approach in all cases. The paper summarizes treatment results, complications as well as pearls and pitfalls of the surgical technique. It is emphasized that transanthral approach reduces surgery time and enophthalmos or diplopy corrections are rarely indicated.