Strobel Lisa, Hölzle Frank, Riediger Dieter, Hilgers Ralf-Dieter, Modabber Ali, Gerressen Marcus
Assistant Dentist, Dental Practice Dr Schumacher, Unna, Germany.
Professor and Chair, Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University (RWTH), Aachen, Germany.
J Oral Maxillofac Surg. 2016 Nov;74(11):2230-2238. doi: 10.1016/j.joms.2016.06.181. Epub 2016 Jul 1.
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 and long-term esthetic and functional outcomes. The aim of this study was to verify the favorable clinical results of the subtarsal approach and compare these results with the transconjunctival procedure.
Forty-five patients (subtarsal group, n = 30; transconjunctival group, n = 15) were examined 6 to 30 months after surgical intervention using a standardized follow-up. Clinically noted complications, such as paresthesia, epiphora, or ocular foreign body sensation, were scored. Postoperative scar formation was investigated using the modified Vancouver Scar Scale (mVSS) and recorded according to standardized photographic documentation procedures. Photographic images were evaluated in a blinded manner by experts and nonexperts according to fixed criteria. Concomitant photographic evaluation was performed by age- and gender-matched healthy controls. Recorded data analyzed by χ test and unrelated samples analyzed by the Wilcoxon-Mann-Whitney test were statistically significant (P = .05).
Comparable complication rates were found for the 2 approaches without any significant differences (P = .29). Using the subtarsal approach, discrete scar formation was discerned in 7 of 30 cases. Moreover, categorization by the mVSS showed that, in 93.3% of cases, the scar was measured as unremarkable hyper- or hypotrophy (mean, 1.7 of 10 possible points). No statistically significant differences in conspicuous scars and asymmetries were observed between the 2 approaches in the nonexpert and expert groups (P > .05).
The results of the present study confirm that the subtarsal approach is a safe and esthetically favorable method.
除经结膜入路外，睑缘下切口是眶底和眶下缘手术探查最常用的方法之一。然而，关于其有效性以及长期美学和功能结果的现有数据有限。本研究的目的是验证睑缘下切口入路的良好临床效果，并将这些结果与经结膜手术进行比较。
45例患者（睑缘下切口组，n = 30；经结膜组，n = 15）在手术干预后6至30个月接受标准化随访检查。对临床上记录的并发症，如感觉异常、溢泪或眼部异物感进行评分。使用改良温哥华瘢痕量表（mVSS）调查术后瘢痕形成情况，并根据标准化摄影记录程序进行记录。专家和非专家根据固定标准对摄影图像进行盲法评估。年龄和性别匹配的健康对照者进行同步摄影评估。通过χ检验分析记录的数据，通过Wilcoxon-Mann-Whitney检验分析不相关样本，差异具有统计学意义（P = .05）。
两种入路的并发症发生率相当，无显著差异（P = .29）。采用睑缘下切口入路时，30例中有7例出现轻微瘢痕形成。此外，根据mVSS分类显示，93.3%的病例瘢痕被评定为无明显增生或萎缩（平均10分制中得1.7分）。非专家组和专家组中，两种入路在明显瘢痕和不对称方面均未观察到统计学显著差异（P > .05）。
本研究结果证实睑缘下切口入路是一种安全且美学效果良好的方法。
