Modified transconjunctival incision for zygomatic and orbital floor fracture - A clinical report

The zygomaticomaxillary complex (ZMC), a key facial structure, is prone to fractures that can cause diplopia, enophthalmos, and motility issues. Traditional surgical approaches are often limited by restricted access and suboptimal aesthetic outcomes. This study evaluated the clinical, functional, and aesthetic outcomes of the Y-modified transconjunctival approach in the treatment of ZMC fractures with orbital floor involvement.

This prospective cohort study was conducted in the Department of Oral and Maxillofacial Surgery. Eleven patients aged 18-65 years with displaced ZMC fractures and orbital floor defects underwent open reduction and internal fixation using a Y- modified transconjunctival approach. Outcomes included pain assessment using the Visual Analog Scale (VAS), complications assessment, scar assessment using the Patient and Observer Scar Assessment Scale (POSAS), and paresthesia. Radiographic assessment was performed using high-resolution computed tomography (CT) scan. Follow-ups were conducted on postoperative days (POD) 1, 10, 28, and 42. The data were statistically analyzed.

A significant pain reduction was observed (mean VAS: POD 1 = 5.82, POD 42 = 1.00; p < 0.01). Only one patient (6.67%) had residual enophthalmos. The POSAS scores showed significant improvements in vascularity, pigmentation, and pliability from POD 10 to 28 (p < 0.01). Patient-reported outcomes confirmed a reduced discomfort and improved scar perception.

The Y-modified transconjunctival approach provides excellent exposure with minimal morbidity, effective fracture stabilization, and favorable functional and aesthetic outcomes in patients with ZMC fractures with orbital floor involvement. Larger studies are required to confirm the broader clinical applicability of this method.