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Cited by 1Facial Trauma and Fracture ManagementReconstructive Facial Surgery TechniquesBone fractures and treatments

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Comparison of Lower Eyelid Complications Among Surgical Approaches for Orbital and Zygomaticomaxillary Fractures: A Network Meta-Analysis

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Chen, Yu-Yen, Chen, Tai-Yuan, Liang, Chun-Min, Chou, Pesus·2026·Journal of Clinical Medicine
DOI 10.3390/jcm15051842PMC PMC12986260
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Abstract

Background/Objectives: This network meta-analysis aimed to evaluate and compare the risks of lower eyelid complications—ectropion, entropion, scleral show, and postoperative scarring—associated with four surgical approaches (subciliary, subtarsal, infraorbital, and transconjunctival) for orbital and zygomaticomaxillary fracture repair. Methods: A systematic search of PubMed, Embase, and Cochrane databases identified relevant studies published between 1 January 1990 and 10 January 2026. Twenty-seven eligible studies involving 2790 patients were included. Direct pairwise meta-analyses and network meta-analyses were conducted to compare complication risks among the approaches. Sensitivity analyses were performed to assess the influence of individual studies, and inconsistency tests were applied to evaluate model robustness. Results: The subciliary approach was associated with the highest risk of ectropion and scleral show. The transconjunctival approach had the lowest risk of ectropion and scarring but the highest risk of entropion. The subtarsal approach had the lowest risk of scleral show, while the infraorbital approach had the highest risk of postoperative scarring. Sensitivity analyses confirmed consistent rankings, and no significant inconsistency was detected. Conclusions: This study provides updated, comprehensive evidence to guide the choice of surgical approach for orbital and zygomaticomaxillary fracture repair. Surgeons should balance operative exposure, cosmetic outcomes, and complication risk, and communicate these trade-offs clearly with patients to optimize decision-making.

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Metadata

Authors
Chen, Y.-Y., Chen, T.-Y., Liang, C.-M., & Chou, P.
Affiliations
  • Johns Hopkins University (US)
  • Taichung Veterans General Hospital (TW)
  • National Chung Hsing University (TW)
  • National Yang Ming Chiao Tung University (TW)
Corresponding author
Chou, Pesus
ORCID
Venue
Journal of Clinical Medicine
Publisher
MDPI AG
Published
2026-02-28
Volume
15
Issue
5
Pages
1842
ISSN
2077-0383 (ISSN-L)
DOI
10.3390/jcm15051842
PMC
PMC12986260
OpenAlex
W7132847246
Cited by
1
References
38
Citations by year
2026: 1
FWCI
1.45
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Taichung Veterans General Hospital (TCVGH-1142201B)
Topics
  • Health Sciences › Medicine › Surgery › Facial Trauma and Fracture Management
  • Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone fractures and treatments
Keywords
orbital fractures, zygomaticomaxillary fractures, fracture healing, subciliary approach, transconjunctival approach, ectropion, entropion, scleral show, postoperative scarring, surgical approach comparison

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