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Transconjunctival versus subciliary approach for orbital fracture repair—an anthropometric evaluation of 221 cases

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Abstract

Objectives

In the literature, there is an ongoing discussion about the influence of orbital fractures and the surgical approach on the rate of eyelid deformities of the lower eyelid.

Materials and methods

We present an evaluation of a series of 221 patients 9 months after zygomaticomaxillary complex fracture repair that underwent implant removal. Reference anthropometric data were measured on standardized pre- and postoperative photographs. Analysis included eye fissure width and height, lid sulcus and upper lid height, upper and lower iris coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, ectropion, and entropion. Both operated and contralateral eyelids were evaluated as well as whether a transconjunctival or a subciliary approach was performed.

Results

Time, surgery, and surgical approach presented significant effects on eye fissure index and lower iris coverage. Scleral show was significantly influenced by the surgical procedure itself as well as by the type of incision. The rate of ectropion increased significantly pre- to postoperative.

Conclusions

The subciliary approach included the highest risk of lower lid retraction. The low pre- to postoperative increase of scleral show and ectropion compared to recent studies gives us an idea about the influence of the underlying trauma on the rate of lower lid retraction. The standardized measurements described are accurately and objective to evaluate postoperative results.

Clinical relevance

The transconjunctival approach is preferable in orbital fracture repair.

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Conflict of interest statement

The authors declare that they have no conflict of interest. There were no sources of funding.

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Authors and Affiliations

  1. Department of Cranio-Maxillofacial Surgery & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Gregor F. Raschke, Rolf-Dieter Bader & Stefan Schultze-Mosgau

  2. Department of Plastic, Reconstructive & Hand Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Ulrich M. Rieger

  3. School of Dentistry, Marquette University, 1801 West Wisconsin, Ave, Milwaukee, WI, 53233, USA

    Arndt Guentsch

  4. Interdisciplinary Research Group of Computational Medicine, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Gregor F. Raschke, Ulrich M. Rieger, Oliver Schaefer & Arndt Guentsch

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  1. Gregor F. Raschke
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Correspondence to Ulrich M. Rieger.

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Raschke, G.F., Rieger, U.M., Bader, RD. et al. Transconjunctival versus subciliary approach for orbital fracture repair—an anthropometric evaluation of 221 cases. Clin Oral Invest 17, 933–942 (2013). https://doi.org/10.1007/s00784-012-0776-3

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  • DOI: https://doi.org/10.1007/s00784-012-0776-3

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