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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
Rivista di Chirurgia Maxillo-Facciale
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2013 April;24(1):15-20
Proposal for the rationalization of surgical access to the orbital floor in the treatment of orbital trauma: evaluation of 200 cases
Baj A., Combi V. A., Goglio L., Russillo A., Giannì A. B.
Department of Maxillo-Facial Surgery, I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
Aim: In this retrospective study the authors compared different approaches to the orbital floor and presented a flowchart for the selection of the surgical approach to treat trauma of the orbital region.
Methods: Two hundred patients underwent orbital surgery for traumatic indications (60 orbital floor pure fractures and 140 orbital associated with orbit-maxillo-zygomatic complex fractures). Transcutaneous approaches were used in 123 cases (subciliary approach in 63 cases and lower lid approach in 44 cases); 77 patients underwent transconjuntival access. Six months after surgery all functional and esthetic aspects of the eyelid were examined.
Results: No ectropion or entropion occurred in any patient. In 32 cases treated by palpebral accesses (16%) we reported scleral show as complication. In one case (0.5%) treated by transconjunctival approach with lateral canthotomy, canthal malposition was observed.
Conclusion: Our experience and literature show that no perfect approach exists. The most suitable method must be selected for each individual case according to the characteristics of the fracture and to the intrinsic and post-trauma anatomical conditions of the eyelid structure. With this paper authors purpose a rationalization of surgical access to the orbital floor in the treatment of orbital trauma.