gms | German Medical Science

Introduction: Although some studies addressed the differences between subciliary and transconjuctival approaches. No previous prospective study on displaced zygomaticomaxillary complex (ZMC) fracture repaired by 3 points fixation using also upper gingivolabial and upper eye lid incisions.

Objective: To compare between transconjunctival and subciliary approaches for open reduction and internal rigid fixation (OR/IF) of displaced ZMC fractures

Methods: 20 Patients were randomly assigned into two equal groups; subciliary group and transconjunctival group for inferior orbital rim repair. In both groups, frontozygomatic and zygomaticomaxillary buttresses were approach by lateral eye brow and superior gingivolabial incision respectively.

Results: The mean exposure time was 13.9 ± 2.1 minutes in subciliary approach and 15 ± 2.36 minutes in transconjunctival approach (p= 0.376). Lateral canthotomy was a must for proper fracture exposure using transconjuctival approach while not needed with subciliary approach. Ectropion and scleral show occurred in 20% and 30% respectively in subciliary group and were not encountered in transoconjunctival group. First week postoperative periorbital edema was more sever in transconjuctival group. Persistent periorbital edema, infection, hematoma and globe complication were not detected in all patients. All authors characterized all scars of the subciliary group as unnoticeable.

Conclusion: Preseptal transconjunctival approach is more time consuming and always needs lateral canthotomy for suitable fractures exposure. Post-operative permanent ectropion and scleral show was reported only in subciliary approach. So building up of experience in transconjuctival approach will be beneficial for maxillofacial surgeons.

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