Subciliary Approach Research Articles

Post-Operative Lower Eyelid Massage Versus Standard Care for Prevention of the Lower Eyelid Scar Contracture after Subciliary Approach in Traumatic Facial Fracture Repair: A Randomized Controlled Trial

Background: Subciliary incision, a common technique for traumatic facial repair, associates with lower eyelid scar contracture and malpositioning. Despite proposed management techniques like eyelid massage, the efficacy of post-operative massage remains unexplored in preventing and treating these issues. Objective: To assess the effectiveness of lower eyelid massage in preventing lower eyelid scar contracture and malposition following the subciliary approach for traumatic facial repair, compared to standard care without massage. Materials and Methods: A randomized controlled trial enrolled patients with traumatic facial fractures slated for subciliary approach repair. Patients were randomly allocated to the lower eyelid massage as the experimental group or standard care as the control group. The massage group received post-operative instructions. Data on demographics, injury profiles, lower eyelid scar contracture as graded by the grading of lower eyelid scar contracture (GLESCO) criteria, eyelid malpositioning, comfort scores, and complications were gathered over a 6-month follow-up. Results: The present study included 59 patients, with 30 in the massage group and 29 in the control group. There were no significant differences in demographic characteristics, injury profiles, or complications between the two groups. Post-operative assessments revealed the massage group exhibited a trend towards lower GLESCO grades with an average decrease of 0.72 grade per week (95% CI –1.46 to 0.02, p=0.058) and lower eyelid malpositioning grades with an average decrease of 0.49 grade per week (95% CI –1.03 to 0.05, p=0.073) compared to the control group. However, there was no significant difference in comfort scores between the two groups with an average difference of 0.18 score per week (95% CI –1.08 to 1.45, p=0.775). Conclusion: Lower eyelid massage demonstrated potential benefits in preventing lower eyelid scar contracture following traumatic facial repair. However, its impact on eyelid malpositioning and comfort scores was not statistically significant in the present study. Further study with larger sample sizes is warranted to validate these findings. Trial registration: ClinicalTrials.gov, NCT06311318 Keywords: Subciliary incision; Subciliary approach; Lower eyelid massage; Facial fracture; Scar contracture; Eyelid malposition; Ectropion

Lateral Tarsoplasty Combined with a Full-Thickness Skin Graft for Managing Severe Lower Eyelid Ectropion Following the Subciliary Approach for Infra-Orbital Rim Fracture: A Retrospective Observational Study.

Subciliary incision is a common approach for facial fracture surgery; however, it has a higher incidence of lower lid ectropion, which can be particularly challenging for beginning surgeons to manage. This study reports the usage of lateral tarsoplasty combined with a full-thickness skin graft (FTSG) to correct severe ectropion following the subciliary approach for infra-orbital rim fractures. We retrospectively reviewed all facial fracture cases involving infra-orbital rim fractures through a subciliary approach treated in our department between March 2021 and May 2023. Electronic medical records and clinical digital photographs of patients who met the inclusion criteria were reviewed. After reviewing 196 cases that used the subciliary approach, we found 6 patients (3.06%; 4 males and 2 females; mean age, 68.5 ± 4.89 years) with postoperative severe ectropion managed using lateral tarsoplasty and FTSG. The mean ectropion development and correction times after facial fracture surgery were 0.78 ± 0.24 and 0.91 ± 0.37 months, respectively. At the 12-month follow-up, all patients showed favorable outcomes, and the position of their lower eyelids was well maintained without ectropion recurrence. Based on these successful outcomes, lateral tarsoplasty combined with FTSG is proposed to be an effective and straightforward method for managing lower eyelid ectropion caused by facial fracture surgery.

Transconjunctival Approach with Lateral Skin Extension in Orbital Fracture Reconstruction

Introduction : Orbital fractures are commonly featured in various type of facial fracture, including zygomaticomaxillary, naso-orbito-ethmoid, frontal-sinus, Le Fort II, and III fracture patterns. Multidisciplinary surgery is required to restore physiological and aesthetic functions.
 Case Illustration : Three midfacial fracture operations with lower transconjunctival incision approach to 6, 18, and 25 years old patients were performed by maxillofacial team in Al Islam Hospital Bandung. The steps started with lateral canthotomy and continued with transconjunctival incision in a lateromedial direction. With dissection towards the infraorbital rim, lower eyelid is mobilized and can be retracted anteromedially. Two patients was given titanium orbital floor implants and plates, while the youngest patient received absorbable plates. This approach successfully gave wider access to orbital bone and less bleeding during surgery. No complication has been reported with good outcome.
 Discussion : Fracture of the orbital floor may be repaired through transcutaneous, transconjunctival or endoscopic approaches. Transconjunctival approach is the most effective surgical access to infraorbital rim and orbital floor or even to medial orbital wall. The ability to reach periosteum further allows access to great portion of the orbit. Lateral canthotomy allows periosteum to be elevated superiorly for repair of fracture frontozygomatic suture. This approach may decrease the risk of postoperative eyelid retraction than subciliary approach and is aesthetically superior to other approaches.
 Conclusion : Transconjunctival approach has provided wider intraoperative access during orbital fracture reconstruction with easier post operative care, also giving good functional and aesthetic outcome.

Incidence of Complication of Ectropion and Entropion in Transconjunctival and Subciliary Approach for Treatment of ZMC Fracture

Objectives: The purpose of the study was to assess the frequencies of problems associated with ectropion and entropion whether the subciliary or transconjunctival technique is employed to repair ZMC fractures. Methodology: 50 patients with ZMC fractures who underwent surgical treatment in Abbottabad's Ayub Medical College and Teaching Hospitals in 2021–2022 were included in this prospective hospital-based research. Pure ZMC Fractures were required for inclusion, while prior lid laxity, prevalence of trauma-related lid abnormalities, and pan face fractures were required for exclusion. Results: 50 patients in all were engaged over the study's time frame; 28 patients received surgery using the sub ciliary route, with a mean delay of 11.25 days amongst the trauma & the operation, & 22 patients’ used the trans conjunctival method, with a mean delay of 30.60 days. Twelve of the patients with ectropion were men and two were women. Men made up both of the entropion patients. Male patients made up more of the sub ciliary approach group (82%, 22/28) than female patients (18%, 6/28). 14% of patients (3/22) in the transconjunctival approach group were female, whereas 97% (19/22) were male. The gender distribution of the patients in the two clusters did not vary statistically significantly (p=0.12). Conclusion: In terms of postoperative issues like entropion and ectropion, the study's findings revealed that there is no discernible variance amongst the transconjunctival technique and the subciliary technique. It was challenging to draw any conclusions from this study's findings due to the time and patient constraints. Hence, it is advised to repeat the study with a bigger sample size in mandate to obtain more reliable results. Keywords: Transconjunctival approach, Subciliary approach, Road traffic accident (Rta)

Evaluation of the Effect of Subciliary Approaches on Lower Eyelid Position in Infraorbital Rim Fractures.

Periorbital fractures are a condition encountered after high-energy trauma in the face region. In the follow-ups after surgical repair, some changes may occur in the lower eyelid. Scleral show, ectropion, entropion, and canthal malposition are the most common complications. In this study, the effect of subciliary soft tissue approaches on lower eyelid position in patients with infraorbital rim fracture was investigated. Patients admitted with orbital lower rim fracture between January 2017 and January 2021 were included in the study. A total of 90 patients, 15 patients in each group, were followed up for 6 months. Before the operation, the patients were randomly assigned to the groups by an impartial observer and the surgeons who would perform the operation were informed about the method. The patients were divided into six groups according to the type of soft tissue approach for fracture repair. There were 6 groups in total and each group included 15 patients. The mean age was 41.4 in group 1, 50.6 in group 2, 38.2 in group 3, 36.4 in group 4, 38 in group 5, and 39.9 in group 6. There was no statistically significant difference between the groups in terms of age (p = 0.090), gender distribution (p = 0.835), and smoking (p = 0.685). Ectropion was observed in 14 of 73 male patients and 5 of 17 female patients. Ectropion was observed in 9 of 38 smokers and 10 of 52 nonsmokers. When all groups were evaluated together, the scleral show measurement was 0.072 on the operated side and 0.034 on the healthy side. This measurement was statistically significant (p = 0.000). Subciliary skin-only or step incision approaches can be used safely in the exposure of infraorbital rim fractures, but both approaches must be supported by canthopexy.

Polypropylene mesh and conchal cartilage composite graft: a novel technique for orbital floor reconstruction

<p><strong>Background: </strong>Fractures of the orbital floor can occur as a part of maxillofacial trauma and be associated with prolapse of orbital contents into maxillary sinus. It may be associated with entrapment signs mandating surgical repair of the orbital floor. Aim of the study was to study the role of a composite graft in the repair of orbital floor fractures in a tertiary care center.</p><p><strong>Methods: </strong>Retrospective chart review of 16 patients who underwent orbital floor repair in a tertiary care center was undertaken. All patients underwent surgical repair with a composite graft made of cartilage and polypropylene mesh by subciliary approach.</p><p><strong>Results: </strong>Post-operatively, none of the patients had restriction of mobility, diplopia, or globe asymmetry. Mild entropion was noted in two patients but did not require any intervention. No extrusion of the implant was seen.</p><p><strong>Conclusions: </strong>Conchal cartilage and polypropelene mesh composite graft is a reliable and easily available material for the repair of orbital floor defects in almost all kinds of orbital floor fractures.</p>

Loss of Lower Eyelid Bulge after the Reconstruction of Zygomatic Complex Fractures.

Background:Surgery for zygomatic complex fractures primarily aims to obtain facial symmetry. We investigated facial symmetry specific to lower eyelid bulges following zygomatic complex fractures approached through the lower eyelid.Methods:Forty-one consecutive patients underwent treatment of zygomatic complex fractures by swinging eyelid approach or subciliary approach. In both approaches, the periosteum was incised 2 mm caudal to the inferior orbital rim and the orbicularis retaining ligament (ORL) was released. The orbital rim periosteum was interruptedly sutured and reconstruction of the orbital septum or ORL was not performed at the time of closure. In cases with a lower eyelid bulge on the nonfractured side, in a frontal photograph 6 months after the operation, the degree of loss of the lower eyelid bulge on the fractured side was classified as either “none,” “mild,” or “severe.”Results:Lower eyelid bulge was present on the nonfractured side in 19 of 41 patients, all of whom were over 50 years old. Loss of lower eyelid bulge was observed on the fractured side in all cases: 15 cases following the swinging eyelid approach (mild/severe; 6/9) and four cases following the subciliary approach (mild/severe; 2/2).Conclusions:In reconstruction after zygomatic complex fractures, lower eyelid bulges were lost in both the swinging eyelid and subciliary approaches in patients over 50 years old. The cause was thought to be an ORL release or an unintended septal reset-like effect.

The better surgical timing and approach for orbital fracture: a systematic review and meta-analysis.

BackgroundA large number of empirical studies on the surgical timing and approach of orbital fracture have been published, but which surgical timing and approach is better is still a dispute. We use a systematic review and meta-analysis to solve this problem.MethodsWe performed a systematic search in the databases of PubMed, Cochrane Clinical Trials Database, Embase, and Web of Science for relevant literature. The search terms included those concerning or describing orbital fracture, timing, and approach, which are based on population, intervention, control, outcome, and study (PICOS) framework. The statistical software packages RevMan 5.4 and Stata 14.0 were used for data analysis. We sought to evaluate postoperative complications, and results were expressed as odds ratio (OR) with 95% confidence interval (CI). Forest plots, sensitivity analysis, funnel plots, Egger’s test, and risk bias analysis were also performed on the included articles by using the Newcastle-Ottawa scale (NOS).ResultsA total of 7 trials involving 1,283 patients compared the surgical timing of ≤14 days versus >14 days, and another 14 trials involving 1,768 patients compared the surgical strategy of transconjunctival approach (TCA) with that of subciliary approach (SCA) for orbital fracture. The quality of all articles was higher than 7 points, which means all articles were at low risk of bias. Surgery conducted within 14 days significantly reduced the incidence of diplopia (OR: 0.53, 95% CI: 0.34 to 0.83, P=0.005) and enophthalmos (OR: 0.32, 95% CI: 0.12 to 0.83, P=0.02); TCA had a significantly lower incidence of ectropion (OR: 0.20, 95% CI: 0.10 to 0.38, P<0.00001), scleral show (OR: 0.22, 95% CI: 0.12 to 0.38, P<0.00001), and visible scar (OR: 0.15, 95% CI: 0.03 to 0.65, P=0.33) compared to SCA, but had a significantly higher incidence of entropion (OR: 5.41, 95% CI: 1.83 to 15.96, P=0.002). There was no significant publication bias among our included studies.ConclusionsThe operation in ≤14 days is better than that in >14 days. However, regarding the choice of surgical approach, TCA and SCA have their advantages and disadvantages, the exploration of which requires further research.

Scarring Caused by the Percutaneous Approach to Fractures of the Orbit and Orbital Rim.

Percutaneous and transconjunctival approaches are commonly used for fractures of the orbit and orbital rim. However, it leaves visible scarring on the face. Although previous studies reported scarring from the percutaneous approach, few reported the degree of such scarring. The authors examined the degree of scarring associated with percutaneous approaches to fractures of the orbit and orbital rim in the Japanese population. The authors reviewed photographs of patients who were treated surgically for fractures of the orbital floor, medial orbital wall, or zygomatic bone via percutaneous approaches to examine the presence of scarring and deformation. In 36% of all patients, the observers were unable to determine the side on which the surgery was performed. Furthermore, the site of scarring was identified accurately in only 20.6% of the cases in which observers were able to identify the surgical side. The authors' study demonstrated that the subciliary approach left minimal scarring under the eyelashes. On the other hand, the medial canthal approach left depressed and wide scarring, whereas pigmentation was apparent in patients who underwent surgery via the lateral eyebrow approach. Similarly, pigmentation under the eyelashes and at the site of secondary incision was common after the subciliary approach.

Transconjunctival and Subciliary Approach in the Treatment of Orbital Fractures: A Study on Oculoplastic Complication.

(1) Background: The aim of the present study was to compare lower eyelid post-operative complications, such as ectropion, entropion, and scleral show of orbital floor fractures, associated to the subciliary vs transconjunctival approaches. (2) Materials and Methods: A retrospective comparative study of patients who underwent surgery for orbital fractures by means of a transconjunctival or a subciliary approach at the Clinic of Dentistry and Maxillofacial Surgery of the University of Verona from January 2013 through September 2018 was designed. Data related to the trauma and to surgical procedures were retrieved, as well as a series of anthropometric parameters extrapolated from standardized photographs. Statistical analysis was performed on the outcomes. (3) Results: 33 patients underwent surgery by means of a transconjunctival approach and 36 patients by means of a subciliary approach. Ectropion was observed to a greater extent in the subciliary group, however the difference resulted to be not statistically significant. Patients in which osteosynthesis devices were used presented with a greater incidence of scleral show with respect to the remaining patients. No statistically significant difference was observed for any of the parameters taken into account. (4) Conclusions: Since the two approaches does not seem to be associated with remarkable differences in terms of outcomes, the choice of technique should be tailored to the patient’s features and the surgeon’s experience.

The Incidence of Common Complications, Including Ectropion and Entropion, in Transconjunctival and Subciliary Approaches for Treatment of ZMC Fractures.

Statement of the Problem: Treating zygomaticomaxillary complex fractures (ZMC Fx) can result in postoperative complications that should be minimized by choosing the best surgical approach.Purpose: This study compared incidence rates of some common postoperative complications with emphasis on ectropion (an outward curling of the lower eyelid) and entropion (an inward curling of the lower eyelid) occurring with transconjunctival or subciliary approaches for the treatment of ZMC fractures.Materials and Method: This prospective study enrolled 80 patients with ZMC Fx who had been surgically treated. Patients were visited within one month and five months postoperatively by the same surgeon. An information checklist was completed for each patient for clinical assessment of postoperative complications.Results: There was no significant difference between the two groups in the type of trauma (simple or comminuted) (p= 0.1) or the frequency of ectropion and entropion one month and five months postoperatively (p> 0.05). The same results were observed for history of massage under the eye or around the field of surgery (p= 0.151), scleral show (p= 0.414), history of post-surgical epiphora (overflow of tears and accumulation of tear) (p= 0.059), duration of the use of suspension/frost sutures (used to prevent eyelid distortion secondary to wound injury applied at the skin inferior to the incision to help elevate the lid) (p= 0.057), and the use of porex (an alloplastic material over the defect in the orbital floor) (p= 0.91).Conclusion: There was no significant difference between the transconjunctival approach and the subciliary approach in terms of common postoperative complications such as ectropion and entropion.

Comparison of the Recurrence Rate of Entropion via Subciliary Route and Transconjunctival Route in Combined Lateral Tarsal Strip with Retractor Advancement Procedure for Involutional Entropion Correction.

To compare the recurrence rate of entropion via subciliary route and transconjunctival route in combined lateral tarsal strip with retractor advancement procedure for involutional entropion correction. Quasi-experimental study. Department of Eye, Combined Military Hospital, Jhelum Cantt, Pakistan from March 2018 to November 2020. Seventy-eight eyes of 78 patients with entropion were randomly divided into two groups of 39 each. One group underwent a lateral tarsal strip procedure combined with retractor advancement through the subciliary approach; and the second group underwent the same procedure through the transconjunctival approach. A strip of preseptal orbicularis was excised in every case. Recurrence rate of entropion was recorded in both groups at six-month postoperation. Duration of surgery was recorded in each case. Fisher's Exact test was selected to compare the recurrence rate of entropion and independent samples 't' test was elected for comparing duration of surgery among the two groups. The recurrence rate of entropion with transconjunctival route repair was statistically not significant compared with the subciliary route repair (p>0.999). The transconjunctival route repair achieved statistically significant shorter duration of surgical time as compared to the subciliary route (p<0.001). The transconjunctival approach for involutional entropion correction is as effective as the subciliary approach with lateral tarsal strip and retractor advancement procedure. Surgery duration through the transconjunctival route is significantly shorter as compared to the subciliary approach. Key Words:Entropion, Involutional, Lateral tarsal strip, Lower eyelid, Retractor advancement, Recurrence, Subciliary, Transconjunctival.

Functional recovery of neurological deficit among patients with Orbital Fracture due to Craniofacial Traumas

Background: With recent development in imaging and bone fixation technology, the orbital fracture is now considered an emerging reconstruction technique for the fixation of even the most severe injuries. This study aims to explore the success rate of functional recovery through different orbital approaches in orbital fractures and reconstruction in patients having craniofacial injuries with clinical and neurological deficits.&#x0D; Methodology: This observational study was conducted from 2016 to 2018, at the Department of Neurosurgery, Liaquat University of Medical &amp; Health Sciences (LUMHS). A total number of 30 patients were enrolled through consecutive sampling. The patients with any clinical and neurological deficit were included in this study, while the patients with craniofacial fractures with comorbidities were excluded. The evaluation of clinical and neurological deficits in the admitted patients was noted pre-operatively and re-assessment of the same deficit postoperatively was done during the tenure of 1-6 months. All orbital floor fractures were approached via a sub-ciliary or transconjunctival incision with a supraciliary approach used for all supra orbital injuries. The reconstruction of the fracture was done within 5 to 10 days of admission.&#x0D; Results: A total of 30 patients underwent surgery for the repair of an orbital floor fracture. The mean age observed was 32.09±10.36 years. The patient age range was 20-50 years. Among the patients 22 (73.3.0%) were male and 8(26.7%) patients were female. The improvement of symptoms observed after surgical intervention includes sub-ciliary approach that resides the recovery of diplopia (95%), paraesthesia (75%), enophthalmos (100%) and vertical Dystopia (100%). On the other hand, trans-conjuctival approach resides in the recovery of diplopia (95%), paraesthesia (100%), enophthalmos (100%) and vertical Dystopia (100%).&#x0D; Conclusion: It is concluded that the surgical treatment of orbital fracture shows promising results in the recovery of neurological deficit among patients with crani-o-facial injuries. Moreover, the trans-conjuctival approach holds much promising results in the improvement of infra-orbital para-aesthesia (100%) as compared to the sub-ciliary approach (75%).&#x0D;

Repair of unilateral combined orbital floor and medial wall fracture using two titanium mesh plates: a modified technique.

BackgroundCompared to isolated orbital wall fracture, combined orbital floor and medial wall fractures are more likely to be required surgical correction due to a higher possibility of complications. However, it remains a challenge to repair concomitant orbital fracture using a one-piece implant due to the complex anatomic structures of the orbit. Aiming to reduce surgical difficulties and enhance therapeutic effects, we repaired unilateral combined orbital floor and medial wall fractures using two separated modified titanium mesh plates in this study.MethodsA retrospective study was conducted on 21 consecutive patients who presented with unilateral combined orbital floor and medial wall fractures in Tianjin Medical University General Hospital between November 2010 and January 2016. The orbital fractures were repaired with two separated titanium mesh plates. The corner at the transition zone area between the orbital floor and the medial wall was reconstructed simultaneously through a combined transcaruncular and inferior subciliary approach with lateral canthotomy. The pre- and post-operative functions and aesthetic results were evaluated.ResultsPreoperatively, all patients presented with 3.5–6.5 mm enophthalmos, five patients presented with diplopia with ocular motility limitation in injured eyes, and six patients presented with hypoglobus ranging from 1.5 to 3.5 mm. Orbital floor and medial wall fractures of all patients were successfully repaired with two separated titanium mesh plates. Postoperatively, enophthalmos was improved in all patients, which was less than 2 mm on the last follow-up day. Hypoglobus was disappeared in all six patients postoperatively. Diplopia was resolved in five patients within 3 months post operation, and was reduced in one patient.ConclusionsIn cases of unilateral concomitant orbital floor and medial wall fractures, two titanium mesh plates implantation is a safe and effective procedure. It is worthwhile to take the technique into account when the key points to consider when applying this method include reconstruction of the special orbital shape and the complete return reposition of prolapsed intraorbital soft tissues were intended.

Anthropometric changes in the morphology of the lower eyelid after using three different approaches in patients with orbital fractures

PurposeThe aim of this prospective study was to address the anthropometric changes in the morphology of the lower eyelid and esthetic outcomes after performing subciliary, subtarsal, and transconjunctival approaches in patients with orbital and periorbital fractures. Patients and methodsA prospective randomized controlled clinical study was undertaken on patients with orbital floor and infraorbital rim fractures. These were equally divided into three groups: in group 1, the fractures were approached via a stepped subciliary approach; in group 2, they were approached via a subtarsal approach; in group 3, a retroseptal transconjunctival approach was performed. The patients were assessed for anthropometric changes in the morphology of the lower eyelid, esthetic outcomes, and postoperative lower eyelid complications (LLCs). A one-way ANOVA test was used to analyze differences between the operated and non-operated sides and the effect of the surgical approach on anthropometric measurements. ResultsA total of 45 patients were included in the study. All the surgical approaches provided adequate surgical exposure of the infraorbital rim and orbital floor. The subtarsal approach allowed rapid access to the field (10.5 ± 1.9 min). All incisions resulted in adequate postoperative esthetic outcomes. Anthropometric analysis revealed that there were no significant differences between the three approaches, except for measurements of the eye fissure index (EFI) and lower iris coverage (LIC). Mean EFI measurements increased on all operated sides. The subciliary approach showed the highest percentage of increased measurements of this variable (34.5 ± 4.6), followed by the subtarsal approach (32 ± 2.1), and then the transconjunctival approach (31.1 ± 3.7), with p = 0.046. Furthermore, the subciliary approach significantly decreased the measurements of LIC. This change was also bigger with the subciliary approach (1.09 ± 2.3) than with the subtarsal approach (2.1 ± 2.4) or transconjunctival approach (3.4 ± 2.6), with p = 0.048. ConclusionBased on the results of this study, the subtarsal approach is a minimally invasive incision that provides an adequate and direct approach to orbital floor and infraorbital rim fractures, with a favorable periorbital architecture and the lowest incidence of LLCs. Therefore, the subtarsal technique should be preferred over subciliary and transconjunctival approaches.

Transcutaneous approach for orbital augmentation with alloplastic implants in acquired anophthalmia

ABSTRACT Purpose: To report the outcomes of a transcutaneous surgical technique for orbital volume augmentation with secondary alloplastic implants in acquired anophthalmia. Methods: Retrospective case note review of patients who underwent secondary orbital implant insertion through a subciliary incision between January 2006 and December 2017. Collected data included age, gender, type and cause of primary surgery, time interval before secondary implantation, and details of secondary implantation surgery. The main outcome parameters included postoperative appearance, grade of superior sulcus deformity (SSD), implant centration, and prosthesis function. Results: Thirty-eight patients ranging from 2 to 54 years had undergone secondary alloplastic orbital implant placement through the subciliary approach. The mean follow-up was 5.3 years (range: 1–10 years). All the patients showed satisfactory orbital volume with the average SSD was grade 0.74. There were no cases with implant exposure or extrusion. Implant migration occurred in six cases (15.8%). Fitting a prosthesis was possible in all cases. Conclusion: Subciliary secondary orbital implantation is proved to be effective in correcting volume deficiency in acquired anophthalmia with rapid rehabilitation while avoiding anterior surface breakdown and implant exposure.

Prediction of Lower Eyelid Malpositioning After Surgical Correction of Orbital Fracture Using the Subciliary Approach Through the Canthal Area and Orbital Vector Analysis.

A subciliary incision has been widely used not only for blepharoplasty but also for facial fracture surgery. However, lower eyelid malpositioning is one of the most common complications after fracture surgery. A limited number of studies have been conducted on the relationships among evaluation of the canthal area, orbital vector analysis, and lower eyelid malpositioning following the subciliary approach for surgical repair of fractures. The primary goal of this study was to identify and analyze the possible risk factors, including incidence of lower eyelid malpositioning and orbital vector after surgical correction of the orbital fracture. A total of 241 cases of orbital fracture surgery was retrospectively reviewed. Data related to the patient and surgery were collected. Orbital vector and angle that reflects the vector, distance between soft tissue and bone in the lateral canthal area were measured for orbital vector analysis. The relationship between the prevalence of the malpositioning of the lower eyelid and each factor was statistically analyzed. The distance between the soft tissue and bone at the lateral canthal area was statistically significant (P = 0.031). The distance between the soft tissue and bone at lateral canthal area illustrates the lateral side or periorbital anatomical morphology. It could be inferred that patients with a negative orbital vector were relatively more vulnerable to scar formation or lower eyelid malpositioning caused by iatrogenic factors. Therefore, it could be analyzed as a risk factor to predict the malpositioning of the lower eyelid postoperatively.

Causes and Surgical Outcome of Orbital Wall Fractures in Mongolia

Objective: To determine causes, clinical manifestations of orbital wall blowout fractures, and evaluate surgical outcomes. Methods: A retrospective study with repeated measurements was conducted in 194 cases with orbital reconstructive surgery between 2002 and 2017 at Orbita Eye Hospital. The analyzed variables were patient age, sex, causes, and clinical manifestation of orbital wall fractures. Surgical outcomes, implant dependent, and surgical approach complications were prospectively analyzed in 60 patients up to 24 months after the initial surgery. Results: Orbital wall fractures were caused by assault in 82.7% of cases, household accidents 9.9%, car accidents 7.4%, and 0% by a sports injury. Diplopia was noted in 16.7%, extraocular movement limitation in 16.7%, enophthalmos in 23.3% for 24 months, or and more following surgery. In 4.2% of cases, prolapse of the orbital fat was noted using the transconjunctival approach, and 16.6% eyelid retraction with scarring in the subciliary approach. Implant displacement was noted 6.6% of cases in which a silicone sheet was used to reconstruct the fracture defect. Conclusions: Assault was the leading cause of orbital fractures, and this most often occurred in young males in Mongolia. Common signs and symptoms of orbital fractures were enophthalmos, diplopia, and extraocular movement limitation. The range of post-surgical enophthalmos, diplopia, and implant-related complications was consistent with those reported by other studies.

Incidence and Prevention of Cicatricial Scleral Show in the Subciliary Access in Patients With Orbital Fractures.

The authors evaluated 50 patients divided in 2 groups: Group 1, subciliary approach and reconstruction of orbital floor without simultaneous Canthopexy Tarsal Sling; Group 2: reconstruction of orbital floor through subciliary approach with simultaneous Canthopexy Tarsal Sling. Patients, who underwent Canthopexy Tarsal Sling, did not have any scleral show. Instead patients, who did not undergo this prevention technique, had scleral show even if a minor entity. Although there was no muscle or skin removed, in our procedure, but only cutaneous incision, scleral show can appear as a complication. Canthal ligament and tarsus' elasticity influence the incidence of post-surgical scleral show, which is more frequent in elderly patients. Therefore, the authors suggest to prevent it routinely with Tarsal Sling Canthopexy. Canthopexy Tarsal Sling is procedure that stretch tarsal structure and it may help to prevent scleral show.

Risk of Lower Eyelids Malposition in Subciliary Compared to Transconjunctival Approach in Maxillofacial Fractures Management: A Systematic Review and Meta-Analysis.

BACKGROUND:Both subciliary and transconjunctival approaches have been used for decades to visualise the site of the maxillofacial fracture. The most common complication following those procedures is lower eyelids malposition.AIM:This meta-analysis will analyse which approach (subciliary and transconjunctival approaches) is more favourable to decrease lower eyelids malposition incidence.METHOD:This meta-analysis was conducted based on PRISMA guidelines. The electronic search was conducted using keywords (“Lower Eyelids Malposition” OR “Complications” OR “Ectropion” OR “Entropion”) AND (Transconjunctival) AND (Subciliary) AND (Maxillofacial Fractures) in PubMed, The Cochrane Library, and Directory of Open Access Journal (DOAJ). This review included full-text studies (observational and randomised controlled trials) in English comparing subciliary and transconjunctival approach in patients with maxillofacial fractures in the last 10 years. The data collected were the type of fractures and approaches, ectropion and entropion incidence as well as follow-up duration. The risk of bias was assessed using Joanna Briggs Institute critical appraisal checklist. Statistical analysis was done using Review Manager 5.3 (Cochrane, Denmark).RESULT:This study included 3 cohort studies and 2 Randomized Controlled Trial (RCT) studies from 2012 to 2017 with a total of 574 samples. Subciliary approach had a significant higher ectropion incidence when compared to transconjunctival approach (RR = 4.64, 95% CI: 1.68-12.81, p = 0.003). There was also a significant reduction of entropion incidence in patients with subciliary approach compared to transconjunctival approach (RR = 0.16, 95% CI: 0.04 – 0.69, p = 0.01).CONCLUSION:There was no superiority between one procedure toward another since each procedure related to different lower eyelids malpositions.