Subciliary versus swinging eyelid approach to the orbital floor

• Published in: Journal of cranio-maxillo-facial surgery 2008-12, Vol.36 (8), p.439-442
• Main Authors: De Riu, Giacomo, MD, Meloni, Silvio Mario, DDS, PhD, Gobbi, Roberta, MD, Soma, Damiano, Baj, Alessandro, MD, Tullio, Antonio, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Decompression, Surgical - methods; Dentistry; Enophthalmos - surgery; Eyelids - surgery; Female; Follow-Up Studies; Graves Ophthalmopathy - surgery; Humans; Male; Medical sciences; Orbit - surgery; orbital approach; Orbital Diseases - surgery; Orbital Fractures - surgery; Orbital Neoplasms - surgery; orbital surgery; Otorhinolaryngology. Stomatology; Reconstructive Surgical Procedures - methods; Retrospective Studies; Surgery; swinging eyelid; Treatment Outcome; Young Adult
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2008.07.005

Summary In this retrospective study, the authors compare the outcomes of two different approaches to the orbital floor: the classic subciliary versus the transconjunctival plus lateral canthotomy (swinging eyelid). Forty-five patients who underwent orbital surgery (47 approaches) for different indications (orbital fractures, correction of Grave's exophthalmos, tumours of the internal orbit and correction of enophthalmos in secondary trauma) were placed in two groups, depending on the approach. The long-term effects of the incisions, the outcome of the approach and the complications were recorded and compared. The minimum follow-up for inclusion in the study was 1 year. Twenty-three orbits underwent subciliary incision, and 24 underwent swinging eyelid. No ectropion or entropion was seen in any patient. For the swinging eyelid approach, complications included three cases (12.5%) of canthal malposition; for the subciliary approach, five cases (21.14%) of lagophthalmos and 10 visible scars were observed. Our findings show the advantages of the swinging eyelid: better aesthetic results, the same or greater exposure of the orbital floor and the caudal part of the lateral and medial walls, shorter surgical time (sutureless) and a less extended scar. Although in our experience this approach is preferable in orbital surgery, some indications for the subciliary still remain.