Comparison of Transconjunctival versus Subciliary Approach for the Management of Infraorbital Rim Fractures

Abstract

Background: Infraorbital rim fractures are commonly associated with zygomaticomaxillary complex and orbital fractures. Surgical exposure is essential for accurate reduction and fixation.The transconjunctival and subciliary incisions are the two most widely used approaches, each with reported advantages and drawbacks.

Aim and objectives: To compare the transconjunctival and subciliary approaches for management of infraorbital rim fractures.

Materials and Methods: Twenty patients with infraorbital rim fractures were divided equally into two groups treated by the transconjunctival (Group A) or subciliary (Group B) approach. Duration of fracture exposure, ectropion, entropion, scar formation, periorbital oedema, and postoperative pain were assessed on postoperative day 1, at 1 week, and at 1 month. Data were analysed using the independent Student's t-test (SPSS v29; p<0.05 significant).

Results: Mean fracture exposure time was 14.00±1.15 minutes in transconjunctival group (Group A) versus 12.60±0.69 minutes (Group B) (p=0.004). Scar score at 1 month was significantly higher in Group B (1.90±0.87) than Group A (0.00±0.00) (p<0.001), whereas periorbital oedema at 1 week was significantly lower in Group B (p=0.008). Ectropion, entropion, and postoperative pain showed no significant intergroup difference.

Conclusion: Both approaches provide satisfactory surgical access; however, the transconjunctival approach offers superior cosmetic outcome with a concealed scar and is the preferable technique for management of infraorbital rim fractures.