Author(s)
Joel J. Stanek, MD
Affiliation(s)
University of Minnesota
Abstract:
Summary: In this presentation, a new technique for performing transnasal wiring for reconstruction of the medial canthus in patients presenting for delayed repair after nasoorbitoethmoid fracture is described. The authors present a series of patients who have undergone this technique and describe long-term results in treatment of this challenging post-traumatic deformity.Core: Medical Knowledge, Patient CareLevel IV - Case seriesLearning Objectives: N/AStudy: Timely repair with appropriate positioning of the medial canthal tendon in nasoorbitoethmoid (NOE) fracture repair is of vital importance to avoid traumatic telecanthus. Transnasal wire canthopexy is the standard method for repositioning the medial canthus. Despite overcorrection, canthal drift is common, resulting in unsatisfactory results. When untreated or inadequately repaired at the time of injury, delayed telecanthus repair is required, posing an even more challenging reconstruction due to scarring and contracture. Here, we describe a new technique for transnasal wiring in the setting of delayed repair and assess its outcomes.Design: Retrospective review and outcome assessment of delayed telecanthus repair following NOE fracture using a novel technique.Method: Patients who presented with telecanthus in a delayed manner who underwent repair by the senior author were included. The medial orbit is approached through bilateral Lynch incisions. After identification of the medial canthal tendon, a hollow bore spinal needle on a hand drill is used to traverse the lamina papyracea at the posterior superior lacrimal fossa in a posteromedial trajectory through the nasal septum, and contralateral lamina. A titanium wire is passed through the needle and secured to a more anteriorly placed screw on the contralateral side, thereby creating a pulley system against the nasal septum, pulling the medial canthus medial and posterior. If needed, a lateral cantholysis can be performed to allow further mobilization of the medial canthus in the setting of palpebral shortening. The procedure is repeated on the opposite side in bilateral injury. Preoperative and postoperative photographs were analyzed with follow up of over 12 months.Results: Eight patients underwent the described technique for delayed treatment of telecanthus. All patients demonstrated significant aesthetic improvement and decreased intercanthal distance. No postoperative complications were noted.Conclusion: Correction of NOE fractures with repositioning of the medial canthal tendon at the time of injury is critical. Occasionally, however, patients present with unrepaired or inadequately repaired telecanthus, a technically challenging problem to reconstruct. The described technique provides a reliable method for appropriately repositioning the medial canthus in delayed repair. The Lynch incision heals well and avoids the long scars and temporal hollowing often seen using a bicoronal approach.