Objective: ZMO fracture indicated for ORIF can be accessed using many approaches, ‎comparison and evaluation of methods was mandatory to reveal the most convenient approach ‎with special attention to surgical scar appearance and patient's esthetics.‎
Design: Prospective study of the ZMO trauma patients.‎
Participants: Twenty-one patients were operated. Distributed in three groups seven ‎patients in each. Groups represented the three approaches, transconjunctival, subtarsal and ‎subciliary. Additional healthy un-operated patients were examined as control.‎
Methods: Patients suffering from ZMO fracture were randomly distributed and ‎operated using the three mentioned approaches. Patients were evaluated post operatively ‎regarding to esthetic outcome, patient satisfaction, pain, incidence of poor wound healing and ‎the quality of fixation.‎
Results: Modified Vancouver Scar Scale (MVSS) results showed lower values for ‎Transconjunctival approach (‎4 ±1.225) followed by Subtarsal approach (‎6 ±2.83) and highest ‎value for Subciliary approach (‎7.2 ±1.095). With statistically significant difference between ‎Subciliary and Transconjunctival but there is no statistically significant difference between ‎Subtarsal and the other two groups. ‎
Conclusions: The transconjunctival approach was associated with lower rates of ‎complications, patient complaints and pain.‎