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

Complications of preseptal versus retroseptal transconjunctival approach for isolated orbital floor fracture repair: A double-blind, non-inferiority, randomized, split-face controlled trial

INTRODUCTION

Effective surgical access to the orbital floor facilitates surgery and mitigates postoperative complications (PC). The aim of this study was to compare PC between the preseptal and retroseptal transconjunctival approaches (PS-TCA/RS-TCA) for isolated orbital floor fracture (OFF).

MATERIALS AND METHODS

Using a double-blind, non-inferiority, randomized, split-face study design, patients aged ≥ 18 years with bilateral isolated OFF were enrolled. A sample size of 177 eyes per group was determined through power analysis. The primary predictor variable was the surgical approach, and the main outcome was the PC rate at month 6. Statistical analyses were computed with a significance level at 0.05 and the non-inferiority margin at a relative risk (RR) of 0.045.

RESULTS

The final sample included 193 patients (23.3 % female; age, 42.8 ± 18.1 years). Both TCA variants exhibited comparable PC rates (5.2 % for PS-TCA vs. 7.3 % for RS-TCA; P = 0.53; absolute risk, +2.07 % [95 % CI, -2.74 % to 6.89 %]; RR, 1.4 [95 % CI, 0.64 to 3.07]). Approximately one in every 49 patients experiencing PC with RS-TCA (number needed to harm, 48.3).

CONCLUSIONS

Both TCA methods can be used without different PC rates at 6 months postoperatively. Future research should focus on TCA in combination with other surgical approaches for multiple orbital wall reconstruction.

Surgical Approaches to Orbital Fractures: A Practical and Systematic Review

Orbital fractures constitute a significant percentage of all midface injuries. Here, we present a contemporary evidence-based review of the major surgical approaches for orbital wall fractures and analyze the literature to compare all major surgical procedures and their complication rates.

Method

A systematic review was conducted to compare surgical approaches (subciliary, transcaruncular, transconjunctival, subtarsal, and endoscopic) and postoperative complications in patients who underwent surgical fixation of orbital wall fractures. A database search in PubMed (PubMed Central, MEDLINE and Bookshelf) was performed for all articles containing the terms "orbital," "wall," "fracture," and "surgery" with different combinations.

Results

A total of 950 articles were obtained and 25 articles were included, representing an analysis of 1137 fractures. The most frequent surgical approach was the endoscopic (33.3%) followed by the external surgical approaches, specifically transconjunctival (32.8%), subciliary (13.5%), subtarsal (11.5%), and transcaruncular (8.9%). The transconjunctival approach had a statistically significantly higher rate of complications (36.19%), followed by the subciliary (21.4%), and endoscopic approach (20.2%, P < 0.0001). The subtarsal approach had a statistically significantly lower rate of complications (8.2%) followed by the transcaruncular approach (14.0%, P < 0.0001).

Conclusion

The subtarsal and transcaruncular approaches were observed to have the lowest rates of complications, whereas the transconjunctival, subciliary, and endoscopic approaches were reported to have higher rates of complications.

[Objective criteria for choosing an operative approach in case of orbital floor fractures]

OBJECTIVE

The aim of the study Id to determinate of objective criteria for the choice of operative access in fractures of the lower wall of the eye socket.

MATERIAL AND METHODS

As an objective assessment of surgical approaches, the magnitude of the surgical action and the wound depths are used. Computer modeling of transorbital and transantral surgical approach is performed on 390 eye sockets based on computed tomograms with a virtual representation of the eye structure of fractures of the anterior, middle and posterior parts. In case of orbital floor fractures in the anterior part, both transorbital and transantral approaches have satisfactory indicators of operational impact.

RESULTS

For fractures in the posterior part, the transorbital approach in the overwhelming majority of cases shows unsatisfactory parameters of objective criteria. For fractures in the middle part, the transantral approach shows the better parameters. The parameters of transorbital access in this case can be considered satisfactory, however, in orbital floor fractures of the middle part, in order to place the implant on undamaged areas of the bone, access to the posterior part of the orbital floor is also required, which leads to unsatisfactory indicators of transorbital access in this situation.

CONCLUSION

For fractures in the anterior orbital floor sections, both transorbital and transantral approaches can be used, and for fractures in the middle and posterior parts, the transantral surgical approach is preferable. In case of accompanying trauma of the medial orbital wall and an anterior part of the orbital floor, transorbital access is preferable, and in the case of the same accompanying injury, but with a fracture of the posterior part of the orbital floor, a combined approach from the orbit and maxillary sinus can be used.

Comparison of Transconjunctival versus Subtarsal Approach in Orbital Reconstruction with Respect to Post-Operative Complications and Aesthetic Outcome - A Systematic Review

Background

Limited evidence exists regarding the optimal surgical approach for orbital floor reconstruction, resulting in uncertainty regarding the choice of approach with the best aesthetic outcomes and lowest post-operative complications.

Objectives

This systematic review aimed to compare the transconjunctival and subtarsal approaches (STA) in orbital reconstruction in terms of post-operative complications and aesthetic outcomes.

Data Sources

The systematic review was conducted following PRISMA guidelines. PubMed, Google Scholar and Cochrane databases were searched from January 1, 2000 and December 31, 2021.

Study Eligibility Criteria

Eligible studies included clinical studies comparing the transconjunctival and STA approaches in orbital reconstruction. The outcome variables assessed were aesthetic scar, hyperaesthesia, entropion, ectropion, enophthalmos, epiphora and other complications. A total of 346 articles were initially identified, and after evaluation using Mendeley software, 292 articles were reviewed. Finally, five articles that met the inclusion criteria were included in this systematic review.

Study Appraisal and Results

The transconjunctival approach demonstrated superior aesthetic outcomes compared to the STA approach. However, the STA approach had a lower incidence of post-operative complications, including hyperaesthesia, entropion, ectropion, enophthalmos and epiphora.

Limitations

The main limitation of this systematic review is the limited availability of literature directly comparing these two approaches, which precluded the inclusion of randomised controlled trials. Furthermore, the search strategy was restricted to specific databases, namely PubMed/Medline, Google Scholar and the Cochrane Collaboration Library.

Application of customized integration titanium mesh in the treatment of complicated zygomatic complex fractures: A prospective randomized clinical study

The present study aimed to quantitatively evaluate the outcomes of the application of customized integration titanium mesh (CITM) in treating unilateral complicated zygomatic complex fractures. A prospective, randomized, controlled clinical study was conducted. Patients were randomly divided into the experimental group who underwent treatment with CITM, and the control group who underwent treatment just with traditional titanium plates. The X² test and student t-test were used for statistical analyses. Twenty patients who required surgery for unilateral complicated zygomatic complex fracture were included in this study. The results showed that the mean of average distance (AD) between pre- and postoperative CT measurements was 0.487 mm in the experimental group and 1.173 mm in the control group (P < 0.001). Compared with the control group, the experimental group had superior zygomatico-facial symmetry (P＜0.05), a shorter average operation time (150 min versus 229 min; P < 0.001), and a higher rate of anatomic reduction (80.0% versus 30.0%; P＜0.05). In conclusion, CITM deserves to be promoted for the treatment of complicated zygomatic complex fractures. TRIAL REGISTRATION: www.chictr.org.cn (ChiCTR1800016818).

Comparison of the two techniques for involutional lower eyelid entropion: A retrospective study

Evaluation of the surgical outcome and the patient satisfaction between the modified Wies technique and the Jones retractor plication technique for involutional lower eyelid entropion without horizontal eyelid laxity. Patients who underwent the modified Wies technique (group 1) and the Jones retractor plication technique (group 2) for correction of involutional lower eyelid entropion without horizontal eyelid laxity between January 2014 and January 2020 were retrospectively reviewed. Patients with horizontal eyelid laxity; cicatricial, congenital or iatrogenic entropion; and less than 6 months of follow-up time were excluded. The main outcome measures were the recurrence rate, correct anatomical position of the eyelid, symptom relief, and postoperative complications for both groups. 37 patients (41 eyes) in Group 1 and 34 patients (34 eyes) in Group 2 were enrolled in the study. Mean age ± SD was 75.6 ± 8.5 years in Group 1 and 73.4 ± 7.9 years in Group 2 (p:0.255). The mean follow-up time (range) was 24.3 (6-80) months in group 1 and 25.3 (6-78) months in group 2 (p:0.818). Two patients in Group 1 and seven patients in Group 2 had a recurrence during the follow-up period (p:0.07). Based on the results of the study, it seems that the modified Wies technique may be a good alternative in suitable patients, as it has satisfactory surgical results.

Implant malposition and revision surgery in primary orbital fracture reconstructions

The aim of the study was to assess factors leading to revision surgery and implant position of primary orbital fracture reconstructions. A retrospective cohort included patients who underwent orbital floor and/or medial wall fracture reconstruction for recent trauma. Demographics, fracture type, surgery and implant-related variables, and postoperative implant position were analyzed. The overall revision surgery rate was 6.5% (15 of 232 surgeries). The rate was highest in combined midfacial fractures with rim involvement (14.0%), lower in zygomatico-orbital fractures (8.7%), and lowest in isolated blowout fractures (3.8%). Fracture type, orbital rim fixation and implant malposition predicted revision. The best positioning was achieved with patient-specific milled titanium implants (mtPSI) and resorbable materials, whereas the poorest with preformed three-dimensional titanium plates. Combined midfacial fractures with rim involvement in particular have a high risk for orbital revision surgery. Within the limitations of the present study, mtPSIs should be preferred in the reconstruction of primary orbital fractures if possible.