Clinical outcome following use of transconjunctival approach in reducing orbitozygomaticomaxillary complex fractures

The increasing emphasis on the open reduction and internal fixation of orbito-zygomatico-maxillary complex fractures has led to a more critical appraisal of the various surgical approaches to the orbital and zygomatic skeleton. Transconjunctival approach popularized by Tessier although credited to Bourquet in 1924 offer excellent exposure of the orbito-zygomatico-maxillary complex fracture especially the infra-orbital rim, frontozygomatic suture and the orbital floor. The argument against a transconjunctival access focuses primarily on concern about limited exposure that apparently makes accurate reduction and osteosynthesis of displaced fracture fragments difficult or impossible. Also, due to close association with eye and various ocular complications reported in the literature, most of the surgeons feel skeptical about using this approach.

The aim of this study is to analyze the efficacy of transconjunctival approach in the treatment of orbito-zygomatico-maxillary complex fractures by evaluating the functional and esthetic results and its associated complications.

We report a series of eight patients who have undergone fracture repair of the orbito-zygomatico-maxillary complex via a transconjunctival approach. Postoperative patient evaluation was performed with specific attention paid towards wound healing, functional stability, esthetic appearance and postoperative ocular complications. Postoperatively clinical examination along with radiographic examination was done to evaluate the position of the zygoma and determine the adequacy of fracture reduction.

In all the patients excellent surgical exposure has been achieved for reduction and rigid fixation of the fracture fragments. None of the patients had any form of complication related to the approach. There were no postoperative ocular complications. Only one patient had postoperative chemosis which was transient and subsided subsequently. All the patients had excellent esthetic outcome, with symmetry of malar prominence restored and without any evident post-operative complications.

Superior esthetic results and direct simultaneous access to the orbital rim, orbital floor and lateral orbital wall, support the use of the transconjunctival approach as a frontline approach to access the orbito-zygomatico-maxillary complex.