Evaluation of subciliary incision used in blowout fracture treatment: pretarsal flattening after lower eyelid surgery.

BACKGROUND

The skin-muscle flap has been widely used for many years in eyelid surgery. However, lid retraction and pretarsal flattening are considerable cosmetic complications. Furthermore, it has also been reported that damage of the zygomatic branch reduces muscle tone and contributes to the development of various complications. The authors investigated whether denervation of the zygomatic branch affects lid retraction and pretarsal flattening in pure blowout fractures.

METHODS

The authors studied 286 unilateral pure blowout fracture patients from January of 2005 to December of 2006. Mean patient age was 35.6 years (range, 9 to 72 years), the male-to-female ratio was 1.7:1, and the mean follow-up period was 28 months (range, 19 to 40 months). No patients had undergone eyelid surgery previously. Eyelid tone was evaluated using the snap test and the lid distraction test. Pretarsal shape was evaluated using photographs, which were presented to three plastic surgeons and six medical students unaware of surgical information.

RESULTS

Increased laxity was found in only 13 patients (4.5 percent). When viewing photographic comparisons, medical students noticed visible scars in 10 patients (3.5 percent), pretarsal flattening in eight patients (2.8 percent), and eyelid malposition in eight patients (2.8 percent), whereas the plastic surgeons noticed visible scars in 10 cases (3.5 percent), pretarsal flattening in 10 cases (3.5 percent), and eyelid malposition in nine cases (3.1 percent).

CONCLUSIONS

In this study, it can be inferred that pretarsal flattening may not be a problem associated with the skin-muscle flap itself accompanying denervation of the zygomatic branch. Instead, technical expertise, conservation of the buccal branch, and meticulous hemostasis are essential for the prevention of complications.