Subciliary vs. transconjunctival approach for the management of orbital floor and periorbital fractures: a systematic review and meta-analysis

Publication date: Available online 19 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Essam Ahmed Al-Moraissi, Seth R. Thaller, Edward Ellis
PurposeThis study compared complications between subciliary and transconjunctival approaches to the infraorbital rim/orbital floor using systematic review and meta-analysis.Methodsand Methods: A systematic review with meta-analysis was conducted according to the PRISMA guidelines. An electronic search in PubMed, Embase and Cochrane Library was performed. Randomized controlled and controlled (retrospective or prospective) clinical studies with aims of comparing subciliary to transconjunctival approaches in the management of infraorbital rim/orbital floor fractures were included. Outcomes variables were lower lid malposition including ectropion, entropion, scleral shows, canthal malpositions and others complications. An Odds ratio (OR) using Mantel-Haenszel (M-H) test with 95% confidence intervals (95% CIs) of outcomes variables was calculated using a Comprehensive Meta-analysis software. A descriptive analysis of postoperative complications was also presented.ResultsSubciliary approach had a significantly higher incidence of ectropion and scleral show when compared to the subconjunctival approach (p<0.001). The subconjunctival approach had a significantly higher incidence of entropion than the subciliary approach (p<0.001).ConclusionsBoth the subciliary and the transconjunctival approaches are associated with specific complications. Overall, the transconjunctival approach showed the lowest incidence of complications.



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