Stepped Subciliary Skin Muscle Flap Versus Nonstepped Subciliary Skin Muscle Flap for Orbital or Zygomatic Fractures

Kim, Hyung Soo; Lee, Ki Ho; Jeong, Jae Yong; Jeong, Ji Won

Abstract

Malposition of the lower eyelid is probably the most important following lower eyelid incision for orbital or zygomatic fracture repair. Its severity may range from increased scleral show to gross ectropion. There are two major determinants of lower eyelid position after surgery: the integrity of the tarsus, canthal ligaments, and pretarsal orbicularis and cicatrical forces within the skin, orbital septum, and capsulopalpebral fascia. A total of two hundreds and six patients were investigated for functional and aesthetic impairments following treatment of orbital or zygomatic fracture through stepped subciliary skin muscle flap or nonstepped subciliary skin muscle flap and periosteal repair. As a result, the incidence of scleral show, ectropion was reduced with statistical significance after stepped subciliary skin muscle flap and periosteal repair of infraorbital rim than nonstepped subciliary skin muscle flap incision and no periosteal repair. The reason is that stepped subciliary skin muscle flap has following characteristics than nonstepped subciliary skin muscle flap: Enough of the muscle must be left to allow for its normal contraction capacity and permit an adequate support of the palpebral rim. In addition, the remaining muscular volume in the tarsal portion, near the lashes, will be sufficient to maintain the lid tonicity. Also, repair of periosteum provides firm fixation of soft tissue to infraorbital rim and prevent hematoma due to decreased dead space. By combing the stepped subciliary skin muscle flap with periosteal repair of infraorbital rim for orbital or zygomatic fracture repair, it is expeced that complications will be reduced such as scar contracture, scleral show and ectropion.