Advertisement

Re: Ageing increases risk of lower eyelid malposition after primary orbital fracture reconstruction

Published:December 20, 2022DOI:https://doi.org/10.1016/j.bjoms.2022.11.286
      We read the article titled ‘Ageing increases risk of lower eyelid malposition after primary orbital fracture reconstruction’ by Rajantie et al with keen interest and would like to appreciate the authors for their commendable work.
      • Rajantie H.
      • Nikunen M.
      • Raj R.
      • et al.
      Ageing increases risk of lower eyelid malposition after primary orbital fracture reconstruction.
      It truly is a comprehensive study which has been carried out systematically. We agree with the outcome that ageing increases the risk of Lower Eyelid Malposition (LEM) and acknowledge that the transconjunctival incision decreases the chances of LEM in elderly patients. We understand that this is a retrospective study and is bound to have certain limitations. However, we would like to highlight a few observations from our perspective for the benefit of the readers.
      • 1.
        The authors have rightly considered the ‘site of orbital fracture’ as one of the explanatory variables. Isolated medial wall fractures are rare. In contrast, the orbital rims, being prominent, are more prone to get involved in orbital trauma associated with zygomatic complex fractures. Therefore, isolated orbital rim fractures could have been included in the classification.
      • 2.
        Postoperative records of the patient would most probably have had the information pertaining to the kind of wound sustained in the lower eyelid. Hence, it would have been better to classify traumatic wounds as abrasion, laceration, contusion, skin loss etc. Lacerations/skin loss would have had a worse impact than others and would have played a role in the healing of the wound.
      • 3.
        It is well established in the literature that transconjunctival (TC) approaches lead to a lower incidence of ectropion/entropion and should be opted for whenever possible.
        • Al-Moraissi E.A.
        • Thaller S.R.
        • Ellis E.
        Subciliary vs. transconjunctival approach for the management of orbital floor and periorbital fractures: a systematic review and meta-analysis.
        • Yoon S.H.
        • Lee J.H.
        The reliability of the transconjunctival approach for orbital exposure: measurement of positional changes in the lower eyelid.
        Hence this doesn’t add to the existing pool of literature. Instead, a study after the exclusion of all TC approaches could be carried out to find out which other approach can be used in ageing patients.
      • 4.
        Extrinsic factors like smoking, nutrition, chronic sunlight exposure, alcohol use, and intrinsic factors like genetics have been suggested to play a role in the ageing mechanism. Gender differences like Tarsal plate/size and axial ocular globe projection have been proven to play a role in LEM.
        • Rajabi M.T.
        • Gholipour F.
        • Ramezani K.
        • et al.
        The influence of orbital vector on involutional entropion and ectropion.
        This is because positive orbital vector causes more involutional entropion in women and the negative orbital vector causes more ectropion in men. Hence, prospective research with all the factors mentioned above may be carried out for a more robust outcome.
      • 5.
        Data regarding existing comorbidities like diabetes, immunosuppression and drug history seem to be missing and should have been considered.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rajantie H.
        • Nikunen M.
        • Raj R.
        • et al.
        Ageing increases risk of lower eyelid malposition after primary orbital fracture reconstruction.
        Br J Oral Maxillofac Surg. 2022; 60: 1391-1396
        • Al-Moraissi E.A.
        • Thaller S.R.
        • Ellis E.
        Subciliary vs. transconjunctival approach for the management of orbital floor and periorbital fractures: a systematic review and meta-analysis.
        J Craniomaxillofac Surg. 2017; 45: 1647-1654
        • Yoon S.H.
        • Lee J.H.
        The reliability of the transconjunctival approach for orbital exposure: measurement of positional changes in the lower eyelid.
        Arch Craniofac Surg. 2017; 18: 249-254
        • Rajabi M.T.
        • Gholipour F.
        • Ramezani K.
        • et al.
        The influence of orbital vector on involutional entropion and ectropion.
        Orbit. 2018; 37: 53-58