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Abstract

Objective: The purpose of this study was to compare the subciliary approach and the infraorbital approach to access the zygomatic bone and the orbital floor to see subsequent complications such as scar formation, ectropion and entropion development.  
Materials and Methods: In this retrospective cohort study, a sample of 50 patients was selected, of which 25 patients were placed in each group. The data was collected in local hospitals in Peshawar from September 2018 to June 2022. Follow-up was done at 1, 3 and 6 months interval. Three-dimensional computed tomography scans were done for each patient during follow-up period. Clinical photographs were taken to assess scarring, ectropion and entropion. Evaluation was done using Ordinal and Binary Likert’s scale.
Results: Mean age group presenting with zygomatic bone or orbital floor fractures was 26-29 years (p=0.25) with a higher incidence of male patients (p=0.63) and unilateral fractures (p=0.77). Grade 3 scar formation was seen in 88% patients who underwent infraorbital incision whereas only 56% patients showed grade 1 or 2 scar formation in subciliary incision (p<0.001, 95% CI for risk difference: 60% to 92%). Similarly, the rate of entropion was high i.e. 21% in patients of infraorbital incision and no patients of subciliary incision showed entropion formation (p<0.001). Ectropion was seen in 64% patients of infraorbital incision as compared to 24% patients of subciliary incision (p=0.010; 95% CI for risk difference; 11% to 65%).
Conclusions: Subciliary approach when compared to the infraorbital approach may offer superior esthetics and functional outcomes and show decreased chances of complications.