Comparison of Transconjunctival versus Subtarsal Approach in Orbital Reconstruction with Respect to Post-Operative Complications and Aesthetic Outcome - A Systematic Review

BACKGROUND: Limited evidence exists regarding the optimal surgical approach for orbital floor reconstruction, resulting in uncertainty regarding the choice of approach with the best aesthetic outcomes and lowest post-operative complications. OBJECTIVES: This systematic review aimed to compare the transconjunctival and subtarsal approaches (STA) in orbital reconstruction in terms of post-operative complications and aesthetic outcomes. DATA SOURCES: The systematic review was conducted following PRISMA guidelines. PubMed, Google Scholar and Cochrane databases were searched from January 1, 2000 and December 31, 2021. STUDY ELIGIBILITY CRITERIA: Eligible studies included clinical studies comparing the transconjunctival and STA approaches in orbital reconstruction. The outcome variables assessed were aesthetic scar, hyperaesthesia, entropion, ectropion, enophthalmos, epiphora and other complications. A total of 346 articles were initially identified, and after evaluation using Mendeley software, 292 articles were reviewed. Finally, five articles that met the inclusion criteria were included in this systematic review. STUDY APPRAISAL AND RESULTS: The transconjunctival approach demonstrated superior aesthetic outcomes compared to the STA approach. However, the STA approach had a lower incidence of post-operative complications, including hyperaesthesia, entropion, ectropion, enophthalmos and epiphora. LIMITATIONS: The main limitation of this systematic review is the limited availability of literature directly comparing these two approaches, which precluded the inclusion of randomised controlled trials. Furthermore, the search strategy was restricted to specific databases, namely PubMed/Medline, Google Scholar and the Cochrane Collaboration Library.