Risk of Lower Eyelids Malposition in Subciliary Compared to Transconjunctival Approach in Maxillofacial Fractures Management: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND:Both subciliary and transconjunctival approaches have been used for decades to visualise the site of the maxillofacial fracture. The most common complication following those procedures is lower eyelids malposition.AIM:This meta-analysis will analyse which approach (subciliary and transconjunctival approaches) is more favourable to decrease lower eyelids malposition incidence.METHOD:This meta-analysis was conducted based on PRISMA guidelines. The electronic search was conducted using keywords (“Lower Eyelids Malposition” OR “Complications” OR “Ectropion” OR “Entropion”) AND (Transconjunctival) AND (Subciliary) AND (Maxillofacial Fractures) in PubMed, The Cochrane Library, and Directory of Open Access Journal (DOAJ). This review included full-text studies (observational and randomised controlled trials) in English comparing subciliary and transconjunctival approach in patients with maxillofacial fractures in the last 10 years. The data collected were the type of fractures and approaches, ectropion and entropion incidence as well as follow-up duration. The risk of bias was assessed using Joanna Briggs Institute critical appraisal checklist. Statistical analysis was done using Review Manager 5.3 (Cochrane, Denmark).RESULT:This study included 3 cohort studies and 2 Randomized Controlled Trial (RCT) studies from 2012 to 2017 with a total of 574 samples. Subciliary approach had a significant higher ectropion incidence when compared to transconjunctival approach (RR = 4.64, 95% CI: 1.68-12.81, p = 0.003). There was also a significant reduction of entropion incidence in patients with subciliary approach compared to transconjunctival approach (RR = 0.16, 95% CI: 0.04 – 0.69, p = 0.01).CONCLUSION:There was no superiority between one procedure toward another since each procedure related to different lower eyelids malpositions.

Abordagem cirúrgica de fratura blow-out através de acesso transconjuntival

“…Sanjaya et al, (2019) 13 , fizeram uma comparação entre as abordagens subciliar e transconjutival, em que foi avaliada a incidência de entrópio e ectrópio diante das abordagens. Os autores observaram que a abordagem transconjuntival apresentou menor incidência de ectrópio e entropio em relação à abordagem subciliar.…”

Lower eyelid entropion following transconjunctival orbital fracture repair: Case series and literature review

“…[ 7 ] The risk factors for entropion occurrence following fracture repair can be related to surgical approach (transconjunctival vs. subciliary), the extent of fracture (isolated vs. complex), location of the transconjunctival incision (subtarsal, forniceal, or midpoint), the incision modality (cautery or knife), dissection plane (preseptal or retroseptal), and the material used for fracture repair, whether associated with lateral canthotomy and the technique of incision closure. [ 4 , 6 , 7 ] The risk analysis of lower eyelid malpositions following the transconjunctival versus subciliary approach revealed a greater incidence (4.7%) in the transconjunctival group than in the subciliary group (0%). [ 6 ] Kesselring et al .…”

“…[ 4 , 6 , 7 ] The risk analysis of lower eyelid malpositions following the transconjunctival versus subciliary approach revealed a greater incidence (4.7%) in the transconjunctival group than in the subciliary group (0%). [ 6 ] Kesselring et al . reported no lower eyelid malposition with a transconjunctival approach out of 198 orbital fractures repaired using different incisions.…”

Abordaje transconjuntival en comparación con abordaje subciliar para el tratamiento de fracturas orbitarias

“…Encontramos seis revisiones sistemáticas (2,3,4,5,6,7) que incluyeron 17 estudios primarios (8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24) , de los cuales, cuatro son ensayos aleatorizados (13,14,21,23) .…”