Subtarsal versus Transconjunctival Approach – Esthetic and Functional Long-Term Experience

Purpose In addition to the transconjunctival approach, the subtarsal incision is one of the most commonly used procedures for surgical exploration of the orbital floor and infraorbital rim. However, available data are limited regarding validity as well as long-term esthetic and functional outcome. The aim of this study was to verify favorable clinical results of the subtarsal approach and compare these results with the transconjunctival procedure. Methods A total of 45 patients were examined from 6 to 30 months post-surgical intervention using a standardized follow-up, in which 30 patients were treated by subtarsal and 15 by transconjunctival approaches. Clinically noted complications such as paresthesia, epiphora or ocular foreign body sensation were scaled. Postoperative scar formation was investigated via modified Vancouver Scar Scale (mVSS), and recorded according to standardized photographic documentation procedures. Photographic images were evaluated in a blinded manner by experts and laymen according to fixed criteria. Concomitant picture evaluation was performed by age- and gender-matched healthy controls. Recorded data analyzed by χ -Test, and unrelated samples by Wilcoxon-Mann-Whitney-Test, were statistically significant at p = 0.05. Results Comparable complication rate levels were found for both approaches without any significant differences (p = 1.29). Using the subtarsal approach, discrete scar formation was realized in 7 of 30 cases. Moreover, categorization via mVSS, revealed that in 93.3% of cases, the scar was measured as an unremarkable hyper-/ hypotrophy (mean 1.7 of 10 possible points). No statistically significant differences in conspicuous scars and asymmetries were observed between both approaches, in both nonexpert and expert groups (>0.05). Conclusion Results of the present study confirm that the subtarsal approach is both a safe and esthetically favorable method.