Subciliary Incision with a Frost Suture: A Case Report Along with Review

Case Report

Austin J Dent.2017; 4(5): 1085.

Subciliary Incision with a Frost Suture: A Case Report Along with Review

Sunny Deshmukh*

Department of Oral and Maxillofacial Surgery, D J College of Dental Sciences and Research, India

*Corresponding author: Sunny Deshmukh, Department of Oral and Maxillofacial Surgery, D J College of Dental Sciences and Research, Modinagar, UP, India

Received: May 30, 2017; Accepted: June 30, 2017; Published: July 11, 2017


Injuries in the orbital region have profound functional as well as aesthetic implications. Treatment of orbital fractures remains one of the most controversial issues in maxillofacial trauma with regard to the classification, diagnosis, surgical approach and treatment. The purpose of the article is to discuss a case report of orbital rim fracture operated using subciliary incision with a frost suture and review pertinent literature.

Keywords: Subciliary incision; Inferior orbital rim fracture; Ectropion


Orbital fractures represent one of the more common conditions encountered after motor vehicle accidents resulting in loss of an aesthetically pleasing appearance [1]. The management of orbital floor fractures has changed significantly over past decades with introduction of new materials and methods of reconstruction there are several surgical interventions recommended based on clinical examination and radiographic examination but the consequences of inadequate repair of orbital floor fractures can lead to significant facial asymmetry and visual defects. Conventional approach to the infraorbital rim/orbital floor has been by cutaneous infraciliary incisions namely the subciliary, mid lower eyelid or subtarsal and infraorbital incisions. These approaches leave behind a scar which may be cosmetically disfiguring at times [2]. The Frost suture is a novel technique to oppose downward tension vectors and to preserve or restore to position of lower eyelid. It was first originally described for the placement of a tarsorrhaphy suture through the upper and lower lid tarsal plates to correct ptosis and then this has been evolved for both the preventive and corrective procedures [3]. The purpose of this case report is to highlight the advantages of subciliary incision with a frost suture (stabilizing suture) as it offers good visualization of anterior fractures and would result in good outcomes in cases of orbital rim and floor fractures, prevents obnoxious scar, ectropion formation.

Case Presentation

A 22 year old young female patient reported to our unit with a complaint of pain and mild swelling over the right eye region. Patient had given a history of fall from motorcycle two days back when he reported to our institution. Patient on examination presented with subconjunctival hemorrhage, periorbital edema, mild enopthalmos and tenderness over the right infraorbital region (Figure 1) and there are no signs of any derangement of globe, any visual loss, impaired papillary reflex or any abnormality in Diplopia test. Basic radiographic examination on Paranasal sinus view revealed fracture of infraorbital rim on the right side (Figure 2), although C.T. scan is gold standard for orbital fractures and patient is not comfortable with it.. Based on the above findings, open reduction and internal fixation of the right infraorbital rim was performed after tarsorrhaphy (Figure 3) and prior to the fixation the entrapment of the muscle is released from the fracture site with subciliary incision (Figure 4). Even though the transconjuctival incision leaves no visible scar but it has its own group of complications like minor granuloma and cyst of lower eyelid. The subciliary incision placed 2mm caudal to cilial line and it gives very nice results as we can observer in postoperative views (Figure 5A and B).