Versatility of Transconjunctival Approach in Maxillofacial Trauma-A Prospective Study and Review of Literature

Abstract

Introduction: Maxillofacial injuries are multiple and complex type of injuries which require multi-specialty management. Maxillofacial trauma can involve the skin, soft tissues, as well as bones resulting in single or multiple fractures. As a result of maxillofacial trauma that leads to disfigurement of the involved areas, patients experience temporary or long-term psychological issues. Aim: The objective of this study was to evaluate the advantages and disadvantages of transconjunctival approach in management of Zygomatico-Orbito-Maxillary Complex (ZOMC) fractures. Materials and Methods: A total of 160 cases of ZOMC fractures were treated from April 2009 to March 2010, in which 37.5% of them had orbital trauma and needed surgery based upon the bony displacement. A total of 10 patients who had sustained zygomatic maxillary complex and orbital fractures were included in this study with follow-up period of 3 years. Post-operative evaluation in the form of assessment of wound healing, functional stability, aesthetic appearance, and associated ocular complications, ectropion, entropion, granuloma formation, canthal displacement, epiphora, diplopia, and infection were evaluated in this study. Results: Mean age of patients was 31.5 years; Mean time of exposure was 20.6 minutes and intra-operative complication was seen in 20% of the cases. In all cases post-operative aesthetic results were satisfactory and good. Acceptable minimal scar was seen in 2 cases (20%) with lateral canthal incision. Conclusion: The transconjunctival incision offers a simple alternative for orbital floor and infraorbital rim fracture, without post-operative complications. This study shows that there were no disadvantages to transconjunctival retro-septal approach, if performed meticulously by an experienced surgeon with sound knowledge of the anatomy of periorbital tissues.

Keywords

• infra-orbital
• lateral canthotomy
• maxillofacial injury
• orbital fracture
• sub-ciliary
• zygomatic maxillary complex