Medial Canthopexy using Modified Hiraga's Incision for Correction of Traumatic Telecanthus

PURPOSE: Traumatic telecanthus can result from naso-ethmoid-orbital fractures. Repair of the medial canthal tendon(MCT) using transnasal wiring is regarded as a choice of method to treat telecanthus, however, is often complicated by incomplete anchoring and drift of canthus, extrusion of wire, in-fracture of orbital bone, and eye damage. The authors introduced oblique transnasal wiring method through the Hiraga's epicanthopalsty incision instead of well-known classical bicoronal approach. METHODS: Five patients with traumatic telecanthus were treated with this method. Though the Hiraga's epicanthoplasty incision, we could approach the operative field; the medial orbital wall and detached MCT. Oblique transnasal wiring was performed as following steps. After slit skin incision on the contralateral nasal recession area, drill holes were made from this point to the superior and posterior point of lacrimal sac of deformed eye. A 2-0 wire was double-passed through the holes and MCT. Traction was applied to ensure pulling the MCT and the wires were twisted in the contralateral nose, securing the MCT in the correct position. RESULTS: All patients except 1 person showed improvement and rapid recovery. On average each canthus was moved 5.6mm medially. In all cases, there were no eyelashes disappear, lacrimal canaliculitis, lacrimal duct injury, or infections. CONCLUSION: The Hiraga's epicanthoplasty incision could give sufficient operative field to reattach the MCT in traumatic telecanthus patients. And the oblique transnasal wiring technique is effective for the Asians who have flat nose and exophthalmic eye. The authors conclude that this technique could be a simple, safe and scarless method to correct traumatic telecanthus.

The effects of Modified Transnasal Wiring on the Teleeanthus

We report 10 cases of the patients with telecanthus undergone modified transnasal wiring procedure between May, 1986 and December, 1990. The procedure of this operation is characterized as follow: Each wire is traversed through 2 holes in nasal bone to the medial canthal ligament. After piercing through the ligament, the wire is returned to the opposite medial canthal ligament over the nasal bone. Ultimately 2 ends of each wire are tied together on one side without silicone sheath. We believe that this modified procedure is more effective and simple for the correction of telecanthus with less recurrence rates than conventional method.