Incisions for Orbital Floor Exploration

Abstract

Incisions used for orbital floor exploration continues to remain a topic of controversy. Historically, 3 incisions have been used for orbital floor repair: transconjunctival, subciliary, and subtarsal. Past studies have attempted to stratify the superiority of one incision over the others. Insufficient level of evidence and inconsistent methodology have lead to inconclusive data. Our authors performed a systematic review of literature to assess the quality of evidence in literature and recommend guidelines for incisions for repairing orbital fractures. Thirty-one articles were identified, comprising a total of 4688 incisions. Technique along with individual benefits and complication profiles for each incision is reviewed. Objectivity and follow-up time intervals are necessary parameters for evaluating incisions for orbital floor exploration to further define guidelines.

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“…Subciliary approaches have been associated with much higher complication rates and 12.9% of cases result in ectropion. 8 Subtarsal approach is associated with less ectropion and depending on its correct placement, conspicuous scar rates are low, around 1 to 3%. [9][10][11] The preference for most surgeons is a transconjunctival approach of the orbital floor due to its very low complication rates (less than 1% in several series) and absence of a visible scar.…”

Surgical Approach in the Repair of Four Different Orbital Wall Fractures and Results in Four Years

“…Fraktürün geliştiği duvar ve yerleşimine göre cilt insizyonu, transkonjonktival, subtarsal veya mediyal duvar için transkarünküler orbitotomi gibi seçe-nekler mevuttur. [18][19][20] Han ve ark., mediyal ve alt duvar fraktürünün birlikte görüldüğü hastalarında, bir gruba sadece subsiliyer cilt insizyonu, bir gruba da subsiliyer cilt insizyonuna ek olarak transkarünküler yaklaşımla çift insizyon yaptıklarını, çift insizyonla fraktür bölgesini daha iyi vizüalize ettiklerini, ancak başarı açısından iki grup arasında fark saptamadıklarını bildirmişlerdir. 21 Cerrahi yaklaşımımızı; fraktür bölgesi, fraktürün büyük-lüğü ve etkilediği duvar sayısı, cilt kesisinin olup olmadığı, kesinin düzgün olup olmadığına göre belirledik.…”

Evidence-Based Medicine

“…61 The subtarsal incision offers direct orbital floor access and is less techni cally demanding, but may leave visible scarring. 60 A recent comprehensive review of incision techniques found insufficient highlevel evidence to suggest one pattern over another, but did show a low incidence of complications with transcon junctival approaches, the highest rate of complica tions and revisions in subciliary approaches, and the lowest revision rate with subtarsal incisions. 60 It should be noted that the transcaruncular inci sion pattern may be associated with increased ophthalmic complications, including nasolacri mal obstruction caused by scar tissue formation.…”

“…60 A recent comprehensive review of incision techniques found insufficient highlevel evidence to suggest one pattern over another, but did show a low incidence of complications with transcon junctival approaches, the highest rate of complica tions and revisions in subciliary approaches, and the lowest revision rate with subtarsal incisions. 60 It should be noted that the transcaruncular inci sion pattern may be associated with increased ophthalmic complications, including nasolacri mal obstruction caused by scar tissue formation. 62 Although the rates of reported complications are low and this incision pattern is gaining in popular ity, it is not currently in widespread use.…”

“…Many have abandoned the subciliary incision, which has demonstrated an unacceptably high risk of cicatri cial ectropion. 60 The transconjunctival approach has been most extensively studied, 60 and shows low rates of complications and leaves no visible scar; however, this approach often requires lateral canthotomy for complete exposure and there is a small risk of cicatricial entropion with this inci sion pattern. Furthermore, a higher incidence of ectropion was found in patients with previous external eyelid incisions.…”