TRANSCONJUNCTIVAL APPROACH FOR SURGICAL REPAIR OF INFRAORBITAL RIM FRACTURES AND ORBITAL FLOOR FRACTURES
Authors:
J. Abelovský; R. Slávik; B. Hocková; D. Štorcelová; J. Gembeš; F. Kubec; E. Kilipiris; A. Stebel
Authors‘ workplace:
Banská Bystrica
; Klinika maxilofaciálnej chirurgie SZU a FNsP F. D. Roosevelta
Published in:
Čes. a slov. Oftal., 79, 2023, No. 4, p. 170-176
Category:
Original Article
doi:
https://doi.org/10.31348/2023/22
Overview
Aims: The aim of this study is to retrospectively evaluate the use of a transconjunctival surgical approach in maxillofacial surgery on the fractures of the infraorbital rim and the orbital floor by analyzing the operating time, the incidence of perioperative and postoperative complications, as well as the functional and aesthetic outcomes of transconjunctival surgical treatment.
Materials and methods: All the patients on whom we used a transconjunctival approach from December 2017 to December 2021 were included in this retrospective study. The epidemiological causes of fractures of the midface skeleton were analyzed. The length of the operating time of the transconjunctival approach with lateral canthotomy was compared with a control group in which the supraorbital eyebrow approach was performed. In addition, we analyzed the incidence of perioperative and postoperative complications in comparison with publications from other centers.
Results: We used the transconjunctival approach 103 times on 89 patients (in 14 patients the transconjunctival approach was performed bilaterally). In cases where the lateral canthotomy was used to extend the transconjunctival approach, there was no prolongation of the operating time. Perioperative complications included the perforation of the lower eyelid in 2 patients. In the postoperative period we recorded complications in 3 patients. Ectropion of the lower eyelid was present in one patient and entropion of the lower eyelid was observed in two patients. The percentage of perioperative and postoperative complications does not exceed the incidence of complications in transcutaneous approaches on the infraorbital rim.
Conclusion: Based on the results of our study, we can consider the transconjunctival approach, either alone or in combination with lateral canthotomy,
Keywords:
transconjunctival approach – infraorbital rim – orbital floor
Sources
1. Tenzel RR, Miller GR. Orbital blow-out fracture repair, conjunctival approach. Am J Ophthalmol. 1971 May;71(5):1141-1142. doi: 10.1016/0002-9394(71)90592-7
2. Tessier P. The conjunctival approach to the orbital floor and maxilla in congenital malformation and trauma. J Maxillofac Surg. 1973 Mar;1(1):3-8. doi: 10.1016/s0301-0503(73)80005-0
3. Al-Moraissi E, Elsharkawy A, Al-Tairi N, et al. What surgical approach has the lowest risk of the lower lid complications in the treatment of orbital floor and periorbital fractures? A frequentist network meta-analysis. J Craniomaxillofac Surg. 2018 Dec;46(12):2164- 2175. doi: 10.1016/j.jcms.2018.09.001
4. Al-Moraissi EA, Thaller SR, Ellis E. Subciliary vs. transconjunctival approach for the management of orbital floor and periorbital fractures: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2017 Oct;45(10):1647-1654. doi: 10.1016/j. jcms.2017.07.004
5. Pausch NC, Sirintawat N, Wagner R, Halama D, Dhanuthai K. Lower eyelid complications associated with transconjunctival versus subciliary approaches to orbital floor fractures. Oral Maxillofac Surg. 2016 Mar;20(1):51-5. doi: 10.1007/s10006-015-0526-1
6. Raschke GF, Rieger UM, Bader RD, Schaefer O, Guentsch A, Schultze- Mosgau S. Transconjunctival versus subciliary approach for orbital fracture repair-an anthropometric evaluation of 221 cases. Clin Oral Investig. 2013 Apr;17(3):933-942. doi: 10.1007/s00784- 012-0776-3
7. Ridgway EB, Chen C, Colakoglu S, Gautam S, Lee BT. The incidence of lower eyelid malposition after facial fracture repair: a retrospective study and meta-analysis comparing subtarsal, subciliary, and transconjunctival incisions. Plast Reconstr Surg. 2009 Nov;124(5):1578-1586. doi: 10.1097/PRS.0b013e3181babb3d
8. Salgarelli AC, Bellini P, Landini B, Multinu A, Consolo U. A comparative study of different approaches in the treatment of orbital trauma: an experience based on 274 cases. Oral Maxillofac Surg. 2010 Mar;14(1):23-27. doi: 10.1007/s10006-009-0176-2
9. Ridgway EB, Chen C, Lee BT. Acquired entropion associated with the transconjunctival incision for facial fracture management. J Craniofac Surg. 2009 Sep;20(5):1412-1415. doi: 10.1097/ SCS.0b013e3181aee3ee
10. Yamashita M, Kishibe M, Shimada K. Incidence of lower eyelid complications after a transconjunctival approach: influence of repeated incisions. J Craniofac Surg. 2014 Jul;25(4):1183-1186. doi: 10.1097/SCS.0000000000000836
11. De Riu G, Meloni SM, Gobbi R, Soma D, Baj A, Tullio A. Subciliary versus swinging eyelid approach to the orbital floor. J Craniomaxillofac Surg. 2008 Dec;36(8):439-442. doi: 10.1016/j.jcms.2008.07.005
12. Bronstein JA, Bruce WJ, Bakhos F, Ishaq D, Joyce CJ, Cimino V. Surgical Approach to Orbital Floor Fractures: Comparing Complication Rates Between Subciliary and Subconjunctival Approaches. Craniomaxillofac Trauma Reconstr. 2020 Mar;13(1):45-48. doi: 10.1177/1943387520904893
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OphthalmologyArticle was published in
Czech and Slovak Ophthalmology
2023 Issue 4
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