Evaluation of the Effect of Subciliary Approaches on Lower Eyelid Position in Infraorbital Rim Fractures

Abstract Background  Periorbital fractures are a condition encountered after high-energy trauma in the face region. In the follow-ups after surgical repair, some changes may occur in the lower eyelid. Scleral show, ectropion, entropion, and canthal malposition are the most common complications. In this study, the effect of subciliary soft tissue approaches on lower eyelid position in patients with infraorbital rim fracture was investigated. Methods  Patients admitted with orbital lower rim fracture between January 2017 and January 2021 were included in the study. A total of 90 patients, 15 patients in each group, were followed up for 6 months. Before the operation, the patients were randomly assigned to the groups by an impartial observer and the surgeons who would perform the operation were informed about the method. The patients were divided into six groups according to the type of soft tissue approach for fracture repair. Results  There were 6 groups in total and each group included 15 patients. The mean age was 41.4 in group 1, 50.6 in group 2, 38.2 in group 3, 36.4 in group 4, 38 in group 5, and 39.9 in group 6. There was no statistically significant difference between the groups in terms of age ( p  = 0.090), gender distribution ( p  = 0.835), and smoking ( p  = 0.685). Ectropion was observed in 14 of 73 male patients and 5 of 17 female patients. Ectropion was observed in 9 of 38 smokers and 10 of 52 nonsmokers. When all groups were evaluated together, the scleral show measurement was 0.072 on the operated side and 0.034 on the healthy side. This measurement was statistically significant ( p  = 0.000). Conclusion  Subciliary skin-only or step incision approaches can be used safely in the exposure of infraorbital rim fractures, but both approaches must be supported by canthopexy.