Subciliary Closure in Orbital Fractures: A Comparison Between Cutaneous and Cutaneo-periosteal Sutures

The orbital floor is the most fragile region of the facial skeleton and is highly prone to fractures, making precise anatomical restoration essential to prevent complications. Among surgical approaches, the subciliary and transconjunctival techniques are most commonly used. Closure is typically performed in 2 layers: periosteum and skin.

A prospective, experimental, longitudinal comparative study was conducted at a tertiary care hospital in western Mexico between July and October 2024. A total of 100 patients with orbital floor fractures were randomly assigned into 2 groups. Group 1 underwent skin-only closure, whereas group 2 received combined periosteal and skin closure.

Outcomes evaluated included postoperative complications (eyelid retraction and ectropion) and the need for surgical reintervention on days 8, 15, and 30, along with demographic variables and comorbidities. The sample included 88 men (88%) and 12 women (12%), with a mean age of 34.8 ± 12.3 years. A significantly higher incidence of eyelid retraction was observed in the combined closure group during the first week (16% versus 2%; P = 0.014) and second week (20% versus 6%; P = 0.037). No significant differences were found between groups regarding ectropion or reintervention rates at any time point. Smoking, present in 29% of patients, was not associated with increased complications (P = 0.826).

In conclusion, periosteal plus skin closure was associated with a higher incidence of eyelid retraction, without reducing ectropion or reintervention rates compared with skin-only closure.