Comparative analysis of the results of surgical treatment of patients with traumatic injuries of the orbital floor using transconjunctival, subciliary and transantral approaches

Surgical reconstruction in patients with traumatic injuries of the orbital floor (OF) is performed using various surgical approaches. Comparative data on their effectiveness, based on quantitative (including volumetric) criteria with a simultaneous assessment of changes in the orbit and maxillary sinus (MS), remain insufficiently studied. Objective. To perform a comparative clinical and radiological evaluation of the results of surgical reconstruction of the OF in adult patients with unilateral isolated traumatic injuries depending on the used surgical approach. Patients and methods. A multicenter retrospective cohort study was performed. It included 30 patients divided into three equal groups based on the type of surgical approach: transconjunctival, subciliary and transantral. Results of computed tomography (CT) scans of 60 patients performed before and after surgery were analyzed. An assessment of demographic and clinical data, as well as quantitative CT morphometry with three-dimensional segmentation of the orbits and MSs on the injury side and on the intact side in the pre- and postoperative periods, which amounted to 120 segmentations of the orbits and 120 segmentations of the MS (a total of 240 segmentations), were carried out. Additionally, parameters of the bone defect of the OF, density of the inferior rectus muscle of the eye, inclination angle and physiological curvature of the OF as well as position of the surgical implant were evaluated. Results. Baseline demographic, clinical and morphometric characteristics did not differ statistically significantly between groups (p>0.05). Before surgery, in all groups, orbital volume on the injury side was significantly increased compared to the intact side, and volume of the MS was reduced. After the operation, regardless of the approach, a restoration of the orbital volume to values comparable to the contralateral side without intergroup differences was noted (p>0.05). In the transantral approach group, the most complete restoration of the MS volume on the injury side (+3.64 cm3) was observed compared to the transconjunctival (+1.31 cm3) and subciliary (+0.81 cm3) approaches. Along with this, the transantral approach demonstrated significant advantages in terms of qualitative CT signs of the sinus condition (p<0.001). It was also associated with more accurate anatomical restoration of the OF configuration. Conclusion. All studied surgical approaches provide comparable effectiveness in orbital volume restoration. Transantral approach demonstrates advantages in the form of more complete restoration of the volumetric parameters of the MS, its sanitation and more precise anatomical reproduction of the OF configuration in patients. The use of three-dimensional CT segmentation and volumetric analysis allows to objectify assessment of treatment results and can serve as an additional criterion when choosing the optimal surgical approach.