A Comparative Analytical Study of Functional and Esthetic Outcomes of Infraorbital and Subciliary Incisions to Assess the Redundancy of the Infraorbital Approach

Objectives: Multiple surgical approaches exist to access the infraorbital region to treat fractures. As with facial approaches, the onus is on good esthetics at the end of the procedure. Access is either through transcutaneous or transconjunctival approaches. In this study, we compared two transcutaneous approaches, the infraorbital and subciliary approaches, to assess functional and esthetic outcomes. Materials and Methods: This was a comparative analytical study of 22 patients over 18 months with zygomaticomaxillary complex (ZMC) fractures, indicated for open reduction and fixation of infraorbital margin. Patients were randomized into subciliary and infraorbital groups, assessed for intraoperative parameters of time, accessibility, and technique sensitivity and evaluated for postoperative esthetic outcomes of edema, scarring, and any complications such as denting ectropion or scleral show at the end of 1 week, 1 month, 3 months, and 6 months. Results: The intraoperative time was three times greater in the subciliary incision group. The accessibility to the fracture site is excellent in the infraorbital approach, although it was also adequate in the subciliary approach. Regarding the esthetic outcomes, denting, scleral show, and ectropion parameters were observed more in the initial postoperative period in the subciliary group and more scar visibility for the same period in the infraorbital group. However, no significant esthetic differences were present between the two approaches at the end of 6 months. Conclusions: The infraorbital approach has low esthetic and functional complications of scleral show and ectropion with relatively good esthetics and ease of performing for infraorbital and orbital floor fractures.