Objective: This study aimed to compare the vestibular approach versus trans-conjunctival approach in the open reduction and internal fixation of infraorbital rim fracture.

Patients and Methods: This randomized controlled trial was conducted on twenty-two patients with infraorbital rim fracture associated with or without other facial fractures excluding orbital floor that require open reduction and internal fixation. Patients were randomly divided into two equal groups; trans-conjunctival group and intraoral vestibular group. The intraoperative fracture exposure time was recorded in both groups and conducted for statistical analysis. The patients were recalled for clinical assessment of post operative pain, edema, infraorbital nerve (ION) function and eye lid integrity.

Results: The outcome of the studied patients showed that the intraoral vestibular group has significantly shorter exposure time but higher post operative edema that totally resolved by the second week post operatively and transient ION affection in 18.1 % of post trauma free cases while the postoperative orbital movement and eye lid integrity in the intraoral vestibular group was superior than the trans-conjunctival group.

Conclusion: Intraoral vestibular approach shortens the intraoperative time and provide ideal protection of eye ball function and eyelid integrity more than the trans-conjunctival group, but it required proper relaxing dissection of the ION and careful adequate retraction for better accessibility.