Transconjunctival approach vs subciliary skin-muscle flap approach for orbital fracture repair

Abstract

Objective: To compare the transcutaneous and transconjunctival approaches for repair of orbital rim and floor fractures.

Design: We conducted a retrospective study of the occurrence of eyelid retraction following the repair of 63 orbital fracture, 27 with the subciliary skin-muscle flap approach and 36 with the transconjunctival preseptal approach.

Setting: Academic tertiary referral medical center.

Participants: Fifty-nine patients underwent 63 orbital explorations.

Interventions: Of the 27 transcutaneous explorations, 24 were done early within the first 2 weeks of injury and three were performed for correction of late posttraumatic enophthalmos. Of the 36 transconjunctival explorations, 25 were done early and 11 were performed for correction of late posttraumatic enophthalmos.

Outcome measure: Clinically noted complications.

Results: We found a 12% rate of transient ectropion and a 28% rate of permanent scleral show with the subciliary skin-muscle flap approach compared with no transient ectropion and a 3% rate of permanent scleral show with the transconjunctival approach.

Conclusions: We believe that the transconjunctival approach provides excellent exposure with less risk of postoperative eyelid retraction and ectropion.