A COMPARATIVE STUDY OF COMPLICATIONS OF SUBCILIARY INCISION VERSUS INFRAORBITAL INCISION FOR ACCESS TO THE ZYGOMATIC BONE AND ORBITAL FLOOR FRACTURE
DOI:
https://doi.org/10.33279/jkcd.v15i03.874Keywords:
Zygoma Fracture, Orbital Floor Reconstruction, Subciliary Incision, Infraorbital Incision, Scar, Entropion, EctropionAbstract
Objective: The purpose of this study was to compare the subciliary approach and the infraorbital approach to access the zygomatic bone and the orbital floor to see subsequent complications such as scar formation, ectropion and entropion development.
Materials and Methods: In this retrospective cohort study, a sample of 50 patients was selected, of which 25 patients were placed in each group. The data was collected in local hospitals in Peshawar from September 2018 to June 2022. Follow-up was done at 1, 3 and 6 months interval. Three-dimensional computed tomography scans were done for each patient during follow-up period. Clinical photographs were taken to assess scarring, ectropion and entropion. Evaluation was done using Ordinal and Binary Likert’s scale.
Results: Mean age group presenting with zygomatic bone or orbital floor fractures was 26-29 years (p=0.25) with a higher incidence of male patients (p=0.63) and unilateral fractures (p=0.77). Grade 3 scar formation was seen in 88% patients who underwent infraorbital incision whereas only 56% patients showed grade 1 or 2 scar formation in subciliary incision (p<0.001, 95% CI for risk difference: 60% to 92%). Similarly, the rate of entropion was high i.e. 21% in patients of infraorbital incision and no patients of subciliary incision showed entropion formation (p<0.001). Ectropion was seen in 64% patients of infraorbital incision as compared to 24% patients of subciliary incision (p=0.010; 95% CI for risk difference; 11% to 65%).
Conclusions: Subciliary approach when compared to the infraorbital approach may offer superior esthetics and functional outcomes and show decreased chances of complications.
References
Kim JH, Kim YS, Oh DY, Jun YJ, Rhie JW, Moon SH. Efficacy of Altered Two-Point Fixation in Zygomaticomaxillary Complex Fracture. Biomed Res Int. Mar 18, 2020.
Sardar T, Farooq SU, Sheikh G. Patterns and management of Zygomaticomaxillary Complex Fractures In Motorbike Accidents. Adv Basic Med Sci. 2019;3(1): 36-41.
C. Ungari, F. Filiaci, E. Riccardi, C. Rinna, G. Iannetti. Etiology and Incidence of Zygomatic Fracture: A Retrospective Study Related to a Series of 642 Patients. Eur Rev Med Pharmacol Sci 2012; 16 (11): 1559-1562.
Bradley D, Leung B, Saxena S, Dungarwalla M, Chapireau D, Fan K. Surgical Management of Zygomatic Complex Fractures in a Major Trauma Centre. Plast Aesthet Res 2019;6:11.
Obuekwe O, Owotade F, Osaiyuwu O. Etiology and Pattern of Zygomatic Complex Fractures: A Retrospective Study. J Natl Med Assoc. 2005 Jul;97(7):992-6.
ALI AA. Epidemiological Study of Zygomatic Fractures: A Five-Year Retrospective Analysis in a Single Hospital Experience. Egypt, J. Plast. Reconstr. Surg. 2020 Oct;44(4): 527-533.
Vybhavi MK, Prashanth V, Srinivas V. Management of Unilateral Zygomaticomaxillary Complex Fracture: A Case Report. J Evolution Med Dent Sci2021;10(35):3070-3073.
Starch-Jensen T, Linnebjerg LB, Jensen JD. Treatment of Zygomatic Complex Fractures with Surgical or Nonsurgical Intervention: A Retrospective Study. Open Dent J. 2018 May 21;12:377-387.
Sanjaya IGPH, Hamid RRH, Adnyana IMS, Purwanthi IGAP, Magdalena P, Mardhika PE. Risk of Lower Eyelids Malposition in Subciliary Compared to Transconjunctival Approach in Maxillofacial Fractures Management: A Systematic Review and Meta-Analysis. Open Access Maced J Med Sci v. 2019 Sep 15;7(17):2953-2957.
Wilson S, Ellis E. Surgical Approaches to the Infraorbital Rim and Orbital Floor: The Case for the Subtarsal Approach. Journal of Oral and Maxillofacial Surgery. 2006 Jan;64(1):104-107.
Bhattacharjee K, Ghosh S, Ugradar S, Azhdam AM. Lower Eyelid Blepharoplasty: An Overview. Indian J Ophthalmol 2020;68:2075-83.
Chandran VS, Candamourty R, Thangavelu A. The Versatility of Lower Eyelid Blepharoplasty Incision: In Open Reduction and Fixation of Zygomatic Complex Injuries. J Nat Sci Biol Med. 2012 Jul;3(2):161-167.
Trindade PA, Vieira EH, Gabrielli MAC, Gabrielli, Pereira-filho VA. Treatment and Complications of Orbito-Zygomatic Fractures. Int. J. Odontostomat. 2012; 6(3):255-262.
Giraddi GB, Syed MK. Preseptal Transconjunctival vs. Subciliary Approach in Treatment of Infraorbital Rim and Floor Fractures. Ann Maxillofac Surg 2012;2:136-40.
Subramanian B, Krishnamurthy S, Kumar SP. Comparison of Various Approaches for Exposure of Infraorbital Rim Fractures of Zygoma. J. Maxillofac. Oral Surg. 2009;8, 99–102.
Song SH, Kwon H, Oh SH, Kim SJ, Park J , Kim SII. Open Reduction of Zygoma Fractures with the Extended Transconjunctival Approach and T-bar Screw Reduction. Arch Plast Surg. 2018 Jul; 45(4): 325–332.
Bhatti MA, Riaz E, Razi A, Ahmed S, Ahsan F, Nadeem R. Incidence of Complication of Ectropion and Entropion in Transconjunctival and Subciliary Approach for Treatment of ZMC Fracture. Pakistan Journal of Medical & Health Sciences. 2023;16 (12):693-695.
Shariati SMM, Dahmardehei M, Ravari H. Subciliary Approach for Inferior Orbital Rim Fractures; Case Series and Literature Review. Bull Emerg Trauma. 2014;2(3):121-124.
Jaber MA, Qahtani FA, Bishawi K, Kuriadom ST. Patterns of Maxillofacial Injuries in the Middle East and North Africa: A Systematic Review. Int Dent J, 2021; 4(71), 292-299.
Simsek H, Ozkan G, Demetoglu U, Gursoytrak B, Kocaturk O. Isolated Zygomatic Arch Fracture: A Case Report. Meandros Med Dent J 2017;18:226-30.
Khan SU, Khan M, Khan AA, Murtaza B, Maqsood A, Ibrahim W, Ahmed W. Etiology and pattern of maxillofacial injuries in the Armed Forces of Pakistan. J Coll Physicians Surg Pak. 2007 Feb;17(2):94-7. PMID: 17288855.
Rohrich RJ, Barton FE. Cosmetic and Functional Considerations in the Subciliary Incision. Plast Reconstr Surg. 1996;98(2):319-323.
Palavalli MH, Huayllani MT, Gokun Y, Lu Y, Janis JE. Surgical Approaches to Orbital Fractures: A Practical and Systematic Review. Plast Reconstr Surg Glob Open. 2023 May 15;11(5):e4967.
McCarthy JG. Plastic Surgery: The Fcae. Volume 3. W.B. Saunders; 1990.
Ridgway EB, Chen C, Colohan S, et al. Lower Eyelid Complications Following Midface Fractures: Subciliary vs Transconjunctival approach. J Oral Maxillofac Surg. 2009;67(5):983-987.
Mokal NJ, Desai MF. Evaluation of Infraorbital Incision in Midface Surgery. Indian J Plast Surg. 2014;47(1):51-56.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Junaid Nadeem, Maria Nizam, Zeenia Arbab, Umer Ullah, Hansa Afridi, Musa Zeb, Muhammad Hubaib Afridi, Faryal Gul, Muhammad Huzaifa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes .
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
