Purpose: Subtarsal and transconjunctival approaches are commonly used in maxillofacial trauma repair. The purpose of this prospective study was to compare the incidence of complications associated with these two approaches.

Patients and method: From February 2008 to July 2010, 50 patients who underwent subtarsal or transconjunctival approach were recruited for this study and followed at 2 weeks, 4 weeks and 6 months for examination. The presence of visible postoperative complications (ectropion, entropion, synechiae, conjunctival granuloma, epiphora, chemosis, edema, scleral show, scar) was noted.

Photographs of the periorbital area were taken at 6 months and were studied by a group of experts and lay persons to determine which approach offers the best cosmetic result.

Results: A higher incidence of postoperative edema at four weeks ( p = 0.0366) and visible scars at four weeks ( p = 0.0142) and six months ( p = 0.0032) was observed in the subtarsal approach group. The overall incidence of complications associated with the subtarsal approach on clinical follow-up was also higher at four weeks ( p = 0.0059) and six months ( p = 0.0188).

A similar concordance emerged from photographic analysis, revealing a strong association between the presence of oedema ( p = 0.0167), scars ( p = 0.0644) and the subtarsal approach. The overall severity of complications observed on photographs was lower in the transconjunctival approach group ( p = 0.0003).

Conclusion: This study demonstrates that the transconjunctival approach to the orbit has a lower incidence of complications, both on clinical follow-up and photographic analysis.

Conflict of interest: None declared.