Eyelid Symmetry and Cosmetic Results Following Lateral Paracanthal Incision in the Transconjunctival Approach for...

Lateral paracanthal incision, an extended transconjunctival approach, provides broad exposure of the infraorbital rim and lateral orbital wall while preserving the native lateral canthal anatomy. Although favorable outcomes have been reported, no previous study has quantitatively assessed postoperative eyelid morphology associated with this technique. This study aimed to evaluate the positional impact and cosmetic outcomes of facial fracture repair performed via the transconjunctival approach with a lateral paracanthal incision.

We retrospectively reviewed data from 30 patients (25 men and 5 women; mean age, 50 years) with unilateral periorbital fractures who underwent surgical repair via the transconjunctival approach and lateral paracanthal extension between January 2020 and April 2024. Transverse eyelid length and margin to reflex 2 (MRD2) were measured using standardized frontal photographs obtained at 3 months postoperatively. Equivalence testing was performed with predefined margins of ±1.0 mm for transverse eyelid length and ±0.5 mm for MRD2. Scar visibility was graded on a 4-point scale: grade 0 (best; scar nearly invisible) to grade 3 (worst; prominent scar).

The mean difference between the operated and intact sides was 0.26±0.16 mm for transverse eyelid length (90% CI: -0.0075 to 0.5342 mm) and -0.05±0.12 mm for MRD2 (90% CI: -0.2619 to 0.1619 mm), both within their respective equivalence margins. No ectropion or entropion was detected. Scar grading results were as follows: grade 0 in 15 patients, grade 1 in 11, grade 2 in 3, and grade 3 in 1.

The transconjunctival approach combined with lateral paracanthal incision preserves eyelid symmetry and achieves excellent cosmetic outcomes while minimizing the risk of lateral canthal malposition. These findings confirm the reliability of this extended orbital approach.