Evolution of the surgical approach to the orbitozygomatic fracture: From a subciliary to a transconjunctival and to a novel extended transconjunctival approach without skin incisions.

Summary Background In the last 20 years, surgical approach to the orbitozygomatic fracture has evolved to limit skin incisions and minimize external scars. Methods The treatment approach to the orbitozygomatic fracture was evaluated by a retrospective chart review from 1992 to 2012, and advantages, disadvantages, and complications were studied. Results Surgical approach to the orbitozygomatic fracture has evolved from a subciliary to a transconjunctival approach and to a novel extended transconjunctival approach without skin incisions in the last 20 years. The greatest advantage of using an extended transconjunctival approach is the wide exposure of the inferior orbital rim, orbital floor, lateral orbital wall, and the frontozygomatic suture in an unobstructed operative field without any skin incisions. Precise assessment of the reduction at the sphenozygomatic suture is possible with a wide exposure of the lateral orbital wall. As the dissection plane in a transconjunctival approach is entirely posterior to the lacrimal apparatus, the medial incision can be placed medially beyond the lacrimal punctum and by combining this approach with the transcaruncular approach, a wide operative field for the medial orbital wall can be obtained, which is the most advantageous point for choosing a transconjunctival approach over a subciliary approach. The complication rate was comparable to a subciliary approach. Conclusions The author advocates an extended transconjunctival approach for orbitozygomatic fractures to avoid skin incisions and to precisely assess the reduction status.