Subciliary vs. transconjunctival approach for the management of orbital floor and periorbital fractures: A systematic review and meta-analysis

Purpose: This study compared complications between subciliary and transconjunctival approaches to the infraorbital rim/orbital floor, using systematic review and meta-analysis. Materials and Methods: A systematic review with meta-analysis was conducted according to PRISMA guidelines. An electronic search in PubMed, Embase, and Cochrane Library was performed. Randomized controlled and controlled (retrospective or prospective) clinical studies, with the aim of comparing subciliary to transconjunctival approaches in the management of infraorbital rim/orbital floor fractures, were included. Outcome variables were lower lid malposition including ectropion, entropion, scleral shows, canthal malpositions, and others complications. An odds ratio (OR) of outcome variables, using a Mantel-Haenszel (M - H) test with 95% confidence intervals (95% CIs), was calculated using Comprehensive Meta-analysis Software. A descriptive analysis of postoperative complications was also presented. Results: The subciliary approach had a significantly higher incidence of ectropion and scleral show when compared with the subconjunctival approach (p < 0.001). The subconjunctival approach had a significantly higher incidence of entropion than the subciliary approach (p < 0.001). Conclusions: Both the subciliary and the transconjunctival approaches are associated with specific complications. Overall, the transconjunctival approach shows the lowest incidence of complications. (C) 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.