title: Transconjunctival versus subciliary approach for orbital fracture repair--an anthropometric evaluation of 221 cases.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  The transconjunctival approach is preferable in orbital fracture repair.
authors: Department of Cranio-Maxillofacial Surgery & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors: Gregor F
authors: GF
authors: Raschke
authors: Ulrich M
authors: UM
authors: Rieger
authors: Rolf-Dieter
authors: RD
authors: Bader
authors: Oliver
authors: O
authors: Schaefer
authors: Arndt
authors: A
authors: Guentsch
authors: Stefan
authors: S
authors: Schultze-Mosgau
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001860:Bone Plates; D003228:Conjunctiva / Q000601:surgery*; D020878:Device Removal; D004483:Ectropion; D005123:Eye / Q000033:anatomy & histology; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009915:Orbit / Q000033:anatomy & histology; D009917:Orbital Fractures / Q000601:surgery*; D020273:Orbital Implants; D010781:Photography; D011183:Postoperative Complications; D018709:Statistics, Nonparametric; D055815:Young Adult