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W. Douglas Appling, MD; James R. Patrinely, MD; Thomas A. Salzer, MD

Arch Otolaryngol Head Neck Surg. 1993;119(9):1000-1007.

Abstract
Objective
To compare the transcutaneous and transconjunctival approaches for repair of orbital rim and floor fractures.

Design
We conducted a retrospective study of the occurrence of eyelid retraction following the repair of 63 orbital fractures, 27 with the subciliary skin-muscle flap approach and 36 with the transconjunctival preseptal approach.

Setting
Academic tertiary referral medical center.

Participants
Fifty-nine patients underwent 63 orbital explorations.

Intervention
Of the 27 transcutaneous explorations, 24 were done early within the first 2 weeks of injury and three were performed for correction of late posttraumatic enophthalmos. Of the 36 transconjunctival explorations, 25 were done early and 11 were performed for correction of late posttraumatic enophthalmos.

Outcome Measure
Clinically noted complications.

Results
We found a 12% rate of transient ectropion and a 28% rate of permanent scleral show with the subciliary skin-muscle flap approach compared with no transient ectropion and a 3% rate of permanent scleral show with the transconjunctival approach.

Conclusions
We believe that the transconjunctival approach provides excellent exposure with less risk of postoperative eyelid retraction and ectropion.

(Arch Otolaryngol Head Neck Surg. 1993;119:1000-1007)

Author Affiliations
From the Departments of Otorhinolaryngology and Communicative Sciences (Drs Appling and Salzer) and Ophthalmology and Surgery, Division of Plastic and Reconstructive Surgery (Dr Patrinely), Baylor College of Medicine, Houston, Tex.

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