In the surgical treatment of orbitozygomatic fractures, both subciliary and transconjunctival with lateral canthotomy incisions are used to provide adequate surgical exposure of the infra-orbital margin and the orbital floor, with excellent cosmetic results. However, postoperative complications can occur, with different rates depending on the type of access used.
The objective of this study is to compare and analyze the advantages, disadvantages, and complications of subciliary and transconjutival with lateral canthotomy incisions for the treatment of orbitozygomatic fractures.
A retrospective study was performed from January 2007 to January 2010. We studied 54 patients that underwent surgical treatment of orbitozygomatic fracture. In 30 patients the subciliary approach was used and in 24 the transconjunctival with lateral canthotomy was the chosen one. We evaluated data on surgery, complications, and patient satisfaction.
In the patients which subciliary incision was used, there were 12 (40%) cases of complications: conspicuous scar in 7 (35%) patients, scleral show in 3 (10%), ligament laxity in 1 (3%), and ectropion in 1 (3%). In the patients which transconjutival with lateral canthotomy was used, there were 5 cases of complications: scleral show in 3 (13%) patients, ectropion in 1 (4%), and conspicuous scar in 1 (4%). There was no presence of entropion and epiphora in the patients of the study.
In regard to patient satisfaction, only one patient of each group were unsatisfied (both due to ectropion) and needed revision surgery.
This study shows a slight superiority of the transconjuntival with canthotomy side approach regarding aesthetic results and postoperative complications. Furthermore, it allows the same or better exposure of the floor and the lateral wall of the orbit than the subciliary approach, and prevents another incision to reach the fronto-zygomatic suture.