Subtarsal Versus Transconjunctival Approach: A Long-Term Follow-Up of Esthetic Outcomes and Complications

Abstract

There is limited data that compares the long-term esthetic outcomes in patients who undergo traumatic orbital reconstruction with the subtarsal (STA) and transconjunctival approaches. The purpose of this study is to determine the long-term differences in scarring, cosmesis, and complications between the 2 approaches. Sixty-seven patients were examined on average 39months after surgery. Each patient was evaluated for satisfaction in surgical scarring and complications including diplopia, nerve paresthesia, lid malposition, and epiphora. Photographic images of each patient were reviewed by 3 experienced maxillofacial surgeons and 3 nonmedical personnel to determine if scarring was present and quantify it using the Manchester scar scale (MSS). Scarring was then compared using 3 different objective scales; MSS, modified Vancouver scar scale and the modified Stony Brook scar evaluation scale. Recorded data were analyzed using the χ2 test and Fisher exact test to determine statistical significance (P<.05). No visible scar formation was seen in 61 to 76.5% of patients who had an STA using either of the 3 scales, although the MSS proved to be significantly more accurate when assessing linear periorbital scars than the modified Vancouver scar scale and Stony Brook scar evaluation scale (P<.001). Surgeons were able to correctly identify subtarsal scars in 26.3% of patients, in comparison with the nonmedically trained people identifying just 10.6% of scars. Most of these showed only mild scar formation and are unlikely to have any significant effect on patient's quality-of-life. Overall, 93.3% of patients who had an STA were satisfied with the scar formation. While the transconjunctival approach is a useful technique that offers a surgical approach with no scarring, over the long-term, only a small proportion of STA scars are visible to the average person. Surgeons should consider both approaches and their clinical advantages when treating patients with traumatic orbital injuries.