Trans-tarsal stair-step versus transconjunctival approach in orbito-zygomaticomaxillary fractures: a prospective randomized controlled clinical trial

BACKGROUND: Various techniques have been proposed for treating orbito-zygomaticomaxillary fractures, each with distinct benefits and drawbacks. AIM OF THIS STUDY: To compare Trans-tarsal Stair-Step Lateral Extension of the Transconjunctival approach with transconjunctival approach combined with lateral eyebrow incision in the management of orbital and zygomaticomaxillary complex fractures with respect to accessibility to fracture site and exposure duration as primary aims. MATERIALS AND METHODS: Twenty patients, aged between 18 and 60 years, who has orbito-zygomaticomaxillary complex fractures were randomly assigned to two equal groups: Group A underwent the trans-tarsal stair-step lateral extension of the transconjunctival approach and Group B received the conventional transconjunctival approach combined with lateral eyebrow incision. Intraoperative parameters which were accessibility to fracture site, exposure duration and total operative time and postoperative parameters which were postoperative edema, postoperative scar and esthetic appearance, postoperative pain and infraorbital sensory nerve function objectively, all were assessed. RESULTS: Group A achieved same surgical access to the fracture site as Group B. Group A and group B had same exposure time. Group A had less total operative time than Group B. Group A consistently showed the less postoperative edema at first 48 h, one week, and four weeks. Non noticeable scarring was reported only in Group A patients while group B had a noticeable scar at the lateral eyebrow incision. Within the first 24 h, there was significant difference in pain levels that was noted between the two groups. Group A had faster recovery in sensory nerve function than group B. CONCLUSION: The trans-tarsal stair-step lateral extension of the transconjunctival approach demonstrated favorable postoperative outcomes regarding pain, edema, and sensory recovery compared to the conventional technique with lateral eyebrow incision with same exposure area and no increase in exposure time and less total operative time. TRIAL REGISTRATION: The trial has been retrospectively registered on clinicaltrials.gov (ID: NCT07044258) on 19-6-2025.