Simplified technique for lateral canthal tendon canthopexy

Purpose: Different techniques for lateral canthal suspension have been used in the management of various eyelid malpositions. We describe a simplified technique for lateral canthal suspension and review its outcome along with a review of existing variations. Methods: We conducted a retrospective chart review of 28 eyelids in 22 patients who underwent simplified lateral canthal suspension. Demographics, symptoms at presentation, and associated eyelid malposition were noted. We evaluated the palpebral fissure and margin?reflex distance 2 (MRD2) on the preoperative and final postoperative photographs by using MEEI FACE?gram software. We also reviewed existing literature on different surgical management options for comparison. Results: At three?month postoperative follow?up, presenting symptoms resolved in all cases. The average postoperative decease in palpebral fissure was 0.73 mm (P = 0.018) and the average decrease of the MRD2 was 1.02 mm (P = 0.0003). Recurrence occurred by three months in one eyelid (4%) with ectropion due to moderate eyelid laxity, and this case was managed with tarsal strip procedure. One patient (5%) who had bilateral surgery had asymmetric lower eyelid position and one patient (5%) had persistent edema of the operated eyelid for six months. Conclusion: This simplified canthal suspension is a simple and effective technique that tightens the lateral canthal tendon and improves the lower eyelid position. It can be used in various mild?to?moderate eyelid laxities and has favorable operative characteristics compared with many existing techniques

Upper and lower blepharoplasty technique associated with canthopexy with double pre septal orbicularis muscle elevation with a single suture / Blefaroplastia superior e inferior associada à cantopexia com elevação dupla de músculo orbicular pré-septal em sutura única

ABSTRACT Objective: To describe the upper and lower blepharoplasty technique associated with canthopexy with double pre septal orbicularis muscle elevation with a single suture in order to evaluate the efficacy of the technique. Methods: This is a retrospective study in which the medical records of 5,882 patients who underwent this technique between January 1999 and July 2015 were evaluated. The frequency and main causes of clinical complications and surgical reoperation were analyzed. Results: The incidence of complications found was 12.7% (n=750), being 0.8% (n=47) due to persistent chemosis, 3% (n=176) due to poor lower eyelid positioning, 4.17% (n=245) due to mild eyelid retraction and 4.8% (n=282) because of mild to moderate chemosis. Conclusion: The technique appears to be effective as it is simple and practical, and capable of resulting in positive functional and aesthetic outcomes with low rates of complications.

RESUMO Objetivo: Descrever a técnica de blefaroplastia superior e inferior associada à cantopexia associada à dupla elevação do músculo orbicular pré-septal em uma única sutura e avaliar sua eficácia. Métodos: Trata-se de estudo retrospectivo, no qual foram avaliados 5.882 prontuários de pacientes submetidos à blefaroplastia superior e inferior com a utilização da cantopexia, entre janeiro de 1999 e julho de 2015. Taxas e principais causas de complicações clínicas e reintervenção cirúrgica foram analisadas. Resultados: A incidência de complicações encontradas foi de 12,7% (n=750), sendo 0,8% (n=47) de caso de quemose persistente, 3% (n=176) de mau posicionamento palpebral inferior (ectrópio), 4,17% (n=245) de leve retração pálpebra e 4,8% (n=282) de quemose leve a moderada. Conclusão: A técnica mostra-se eficaz por ser simples e prática, podendo ter resultados funcionais e estéticos positivos e com baixo índice de complicações.

The application of drill hole lateral canthoplasty and canthopexy in correction of lower eyelid malposition / 中华整形外科杂志

Objective@#To investigate the lateral canthoplasty and canthopexy with bone drilling to correct lower eyelid malposition and its benefit.@*Methods@#From January 2014 to January 2019, lateral canthopexy with bone drilling technique was used to repair 56 patients with lower eyelid malposition in Department of Plastic and Reconstructive Surgery of Changhai Hospital. Forty-four patients with lower eyelid ectopic had multiple previous surgeries, and 12 patients had congenital lower eyelid retraction. For patients without lower palpebral margin extension, lateral canthopexy with bone drilling technique was applied. For patients with lower palpebral margin extension, the lateral canthus angle was exposed to shorten the lower eyelid margin. For congenital lower eyelid retraction, the lateral canthus tendon was completely cut off, and then fixed with double armed sutures.@*Results@#Operations were successfully performed on all 56 patients, and the patients were followed up for 1-38 months. Forty-nine patients achieved good eyelid shape and satisfied with the operative effects (87.5%). Malposition was ameliorated in 6 patients (10.7%). One remained uncorrected (1.8%).@*Conclusions@#Lateral canthopexy with bone drilling technique could obtain firm suspension force. For lower eyelid malposition, especially for patients with recurrent malposition or congenital lower eyelid retraction, satisfied function and appearance could be achieved.

A case series of Tessier 3, 4, 7 and combined 4, 7 craniofacial clefts

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To report a case series of Tessier 3, 4, 7 and combined 4,7 craniofacial clefts, their clinical presentations, surgical approaches and outcomes in light of the current literature.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case series<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Subjects:</strong> Five patients<br /><strong>RESULTS:</strong> Five  patients aged 3 to 14-years-old with Tessier 3, 4 (2  cases), 7  and combined 4,7 were included in this study: Tessier 3 - medial orbitomaxillary cleft extending through the bony skeleton traversing obliquely across the lacrimal groove, Tessier 4 - median orbitomaxillary cleft traversing  vertically  through  the  inferior  eyelid,  infraorbital rim and  orbital  floor extending  to the lip between the philtral crest and the oral commissure  (2 cases), Tessier 7 - macrostomia and cleft oral commissure and combined Tessier 4 and 7, combining features described above. Four underwent 2- or 3-stage surgeries while one declined.<br /><strong>CONCLUSION:</strong> Five  craniofacial  clefts  were  presented.  Because  of  the  varying  patterns of craniofacial  deformities,  a  series of surgical  procedures,  tailor-made  for  each  individual  were performed  on  four. Otolaryngologists who perform maxillofacial and cosmetic surgery  should have good background knowledge about craniofacial defects and be familiar with the  surgical approaches at their disposal to yield favorable results that are appropriate to their local contexts.</p>

A case report of lagopthalmos related with facial nerve paralysis

Patient with facial paralysis may develop opthalmic complications. Poor eyelid closure, ectopion and lagophthalmos place the patinet at increased risk for development of corneal problems such as epitheilail defects, stromal thinning, bacterial infection, and even perforation. Inilital treatment should be conservative and include the use of ocular lubricants and taping of the lower eyelid into the proper position. Surgical intervention may be required in patients who have failed medical therapy or in whom the facial paralysis is not expected to improve. Gold weight implantation in upper eyelid and lower lid tightening in lower eyelid has become a popular procedure to correct upper eyelid retraction and lower eyelid laxity and to improve corneal coverage. We describe technique for placement of a gold weight in the upper lid, with attention of the maintenance of symmetric eyelid crease and susture canthopexy to correct malpositioned lower eyelid.

Comparision and Analysis of Various Medial Canthoplasties in Correcting Congenital and Traumatic Epicanthus

Medial canthoplasty is required to correct congenital anomaly and acquired deformity after trauma, especially nasoethmoid orbital fracture and to correct epicanthal fold. Several medial canthal surgical procedures have been used, but the postoperative results have not always been estimated. Between January 1, 1986 and April 30, 2000, 55 medial canthoplasties were performed in 32 patients. We report the experiences with 55 medial canthoplasties and analyze and compare each methods. The patients who underwent medial canthoplasty were analyzed anthropometrically by the ratio of left to right palpebral fissure dimension, the ratio of postoperative to preoperative palpebral fissure dimension and the ratio of postoperative to preoperative intercanthal distance. And every patient was analyzed clinically by ordinary scale method. Of several singly performed medial canthoplasties, del Campo technique was excellent because the ratio was much improved anthropometrically and the clinical assessments were 'excellent'. Of several singly performed medial canthopexies, transnasal wiring was excellent anthropometrically and clinically. Of simultaneously performed medial canthoplasties, del Campo technique with transnasal wiring were excellent because the ratio was much improved anthropometrically and the clinical assessments were 'excellent'. And the results of simultaneously performed medial canthoplasties group was better than that of singly performed medial canthoplasties group. And so, we concluded that del Campo technique with transnasal wiring for severe cases were recommendable for medial canthoplasty.

Lateral canthal anchoring for correction of lower eyelid retraction / 中华医学美学美容杂志

Objective To investigate the ideal methods for correction of lower eyelid retraction by lateral canthal anchoring.Methods The authors retrospectively reviewed the records of 126 patients(207 eyelids) operated on between June 1999 and 2005 by one senior surgeon.The age of the patients ranged from 28 to 72 years(mean,46 years).Transcanrhal canthopexy was used in 20 patients(33 eyes);The 3 mm tarsal strip procedure was used in 35 patients(57 eyes);Transcanrhal canthopexy combined with Hamra's lower blepharoplasty was used in 26 patients(45 eyes).The tarsal strip procedure combined with Hamra's procedure was used in 45 patients(72 eyes).75 patients(123 eyes) were followed up for 6～12 months.Mean follow-up time was 8 months. Results Of them,125 patients were uniformly satisfied with their cosmetic and functional outcome at last follow-up;one patient had undercorrection of retraction.There were no major complications and only one minor complications(corneal irritation from graft sutures),which resolved in the early follow-up period.Conclusions The lateral canthal anchoring is an effective,aesthetic,and functional treatment for moderate to severe lower eyelid retraction resulting from multiple causes.This procedure is associated with predictable results,a low morbidity rate,and high patient satisfaction.