Transconjunctival and Subciliary Approach in the Treatment of Orbital Fractures: A Study on Oculoplastic Complication

Abstract

(1) Background: The aim of the present study was to compare lower eyelid post-operative complications, such as ectropion, entropion, and scleral show of orbital floor fractures, associated to the subciliary vs transconjunctival approaches. (2) Materials and Methods: A retrospective comparative study of patients who underwent surgery for orbital fractures by means of a transconjunctival or a subciliary approach at the Clinic of Dentistry and Maxillofacial Surgery of the University of Verona from January 2013 through September 2018 was designed. Data related to the trauma and to surgical procedures were retrieved, as well as a series of anthropometric parameters extrapolated from standardized photographs. Statistical analysis was performed on the outcomes. (3) Results: 33 patients underwent surgery by means of a transconjunctival approach and 36 patients by means of a subciliary approach. Ectropion was observed to a greater extent in the subciliary group, however the difference resulted to be not statistically significant. Patients in which osteosynthesis devices were used presented with a greater incidence of scleral show with respect to the remaining patients. No statistically significant difference was observed for any of the parameters taken into account. (4) Conclusions: Since the two approaches does not seem to be associated with remarkable differences in terms of outcomes, the choice of technique should be tailored to the patient’s features and the surgeon’s experience.

Lateral Tarsoplasty Combined with a Full-Thickness Skin Graft for Managing Severe Lower Eyelid Ectropion Following the Subciliary Approach for Infra-Orbital Rim Fracture: A Retrospective Observational Study

“…This study outlines the successful correction of severe ectropion complicating the subciliary approach for infra-orbital rim fractures using lateral tarsoplasty combined with FTSG conducted by a single surgeon (this study’s corresponding author) in six consecutive patients, yielding favorable outcomes. The subciliary approach is a conventional and effective method for reducing infra-orbital rim and zygomaticomaxillary complex fractures [ 1 , 2 , 5 , 6 ]. Particularly, in the case of facial fractures involving the infra-orbital rim that should be sufficiently exposed, the subciliary approach is commonly used because it can allow wider exposure than the transconjunctival approach and may achieve less noticeable postoperative scarring than the subtarsal or infra-orbital approach [ 2 , 5 , 6 ].…”

“…The subciliary approach is a conventional and effective method for reducing infra-orbital rim and zygomaticomaxillary complex fractures [ 1 , 2 , 5 , 6 ]. Particularly, in the case of facial fractures involving the infra-orbital rim that should be sufficiently exposed, the subciliary approach is commonly used because it can allow wider exposure than the transconjunctival approach and may achieve less noticeable postoperative scarring than the subtarsal or infra-orbital approach [ 2 , 5 , 6 ]. However, the frequent development of lower eyelid malposition, particularly severe ectropion, is a prevalent long-term complication associated with this approach.…”

“…However, the frequent development of lower eyelid malposition, particularly severe ectropion, is a prevalent long-term complication associated with this approach. These occurrences usually resist conservative interventions, such as a gentle massage and a triamcinolone acetonide injection [ 1 , 2 , 3 , 4 , 5 , 6 ]. The lower eyelid is a crucial structure of the face, both cosmetically and functionally.…”

“…This approach allows a broad view of the operative field, facilitating precise fracture reduction [ 1 ]. However, it is linked to postoperative eyelid complications, including lower eyelid malposition, sclera show, lid edema, entropion, and ectropion [ 1 , 2 , 3 , 4 , 5 , 6 ]. Ectropion, which is characterized by an outward turning of the eyelid margin, exposes the inner eyelid surface, increasing its susceptibility to irritation.…”

The better surgical timing and approach for orbital fracture: a systematic review and meta-analysis

“…After duplicate elimination, 1,083 studies underwent title and abstract screening, resulting in 171 studies considered suitable for inclusion. Following full paper review, 21 articles met the criteria for inclusion, of which 7 were included in the meta-analysis of surgical timing for orbital fracture (23)(24)(25)(26)(27)(28)(29), and the other 14 were included in the meta-analysis of surgical approach for orbital fracture (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). The results of the search process, which followed the Meta-analyses of Observational Studies in Epidemiology (MOOSE) checklist, including reasons for exclusion of studies, are illustrated in Figure 1.…”