Comparison of various approaches for exposure of infraorbital rim fractures of zygoma

Abstract

Objective The aim of this study was to randomly compare four incisionssubciliary, subtarsal, infraorbital and transconjunctival with lateral canthotomy for treatment of orbital rim or floor fractures. Methods 40 patients with zygomatic complex fractures either isolated or in association with pan facial fractures, were selected for the study. They were divided into four groups of 10 patients each, Group I-Transconjunctival with lateral canthotomy, Group II-Subciliary [single eyelid incision], Group IIISubtarsal incision, and Group IV-Infraorbital incision. The following parameters were compared a) The average time from incision to fracture exposure b) The amount of exposure of the site provided c) The aesthetic appearance of the 'scar' d) Complications e) Factor of 'time' -its effect on scar and complications. Results The study revealed that all four incisions provided adequate exposure of fracture site and transconjunctival (22 minutes) required the maximum time for exposure. The complications included ectropion in group I and prolonged edema in group IV. Group II and III patients had relatively lesser number of complications. Group IV patients had visible scar as compared to no scar in group I patients. Conclusion We conclude by saying that transconjunctival approach provides an excellent aesthetic result when done meticulously. However the subciliary and the subtarsal incisions provide a more rapid, direct approach to the orbital floor and infraorbital rim with minimal morbidity and an aesthetically acceptable scar. The infraorbital incision is the least acceptable aesthetically.

Comparison of ‘sutureless’ Transconjunctival and Subciliary Approach for Treatment of Infraorbital Rim Fractures: a Clinical Study

“…The risk of developing postoperative eyelid retraction also varies with the type of approach used to expose the inferior orbital rim and floor. [10,15] Few authors [2,3,10,15] have compared subciliary approach with transconjunctival approach but no study has tried the comparison with 'sutureless' transconjunctival technique on the basis of so many pre-defined parameters with a follow-up of 3 months. We observed that main drawbacks of the subciliary approach include the post-operative scarring and the risk for potential complications.…”

“…Although it may seem that the difference lies only at the level of the incision from the ciliary margin, the anatomy of the region and the plane of dissection also influence the final aesthetic result [3].…”

“…The subciliary incision was popularized by Converse in 1944 and is perhaps the most commonly used 'transcutaneous' approach [3]. The transconjunctival incision initially developed by Bourguet in 1928 for cosmetic procedures, was utilized by Converse and Tessier for the treatment of fractures and congenital malformations [4].…”

“…The transconjunctival incision initially developed by Bourguet in 1928 for cosmetic procedures, was utilized by Converse and Tessier for the treatment of fractures and congenital malformations [4]. Transconjunctival incisons can be pre-septal or post-septal with the former more commonly used for treatment of fractures [3,5].…”

Subciliary Incision with a Frost Suture: A Case Report Along with Review

“…Conventional approach to the infraorbital rim/orbital floor has been by cutaneous infraciliary incisions namely the subciliary, mid lower eyelid or subtarsal and infraorbital incisions. These approaches leave behind a scar which may be cosmetically disfiguring at times [2]. The Frost suture is a novel technique to oppose downward tension vectors and to preserve or restore to position of lower eyelid.…”