“Dynamic Canthopexy” Drill Hole Canthal Repositioning

Abstract

Background Canthopexies can be performed to modify the eye slant, both when the lateral canthus is lower than the medial one (congenital defect) or in case the patient asks for an almond-shaped eye (cosmetic indication). Objectives This peculiar type of canthopexy can be defined as “dynamic canthopexy,” meaning that the lateral canthus is released from its original insertion and raised to a higher position. The goal of this study is to demonstrate the differences and the efficacy of the dynamic cantoplasty. Methods The authors reviewed 30 patients treated with a “dynamic canthopexy” between January 2005 and March 2015. Eighteen patients were affected by true downslanting palpebral fissure, and 12 patients had a normal eye shape but were wishing for a more “Asian” look. Dynamic canthopexy involves a total modification of the canthal suspension system and its careful reconstruction at a higher level inside the orbital rim. To obtain a permanent result, canthal ligament and tendon had to be anchored to drill holes in the orbital rim bone with nonabsorbable sutures. Symmetry was very carefully assessed. The average surgical time was 1 hour. Results This surgery proved extremely effective in all cases. Patients must be warned, though, that an initial hypercorrection is necessary to achieve the desired canthal position. About 6 months after surgery the result of this operation can be considered permanent. Severe complications are rare. Conclusions Dynamic canthopexy can provide stable correction of anti-Mongolian slant. It can also be effectively employed to obtain permanent slant eyes when required by purely cosmetic patients. If precisely carried out, this technique can yield very rewarding outcomes. Level of Evidence: 4

Transconjunctival and Subciliary Approach in the Treatment of Orbital Fractures: A Study on Oculoplastic Complication

“…Al-Moraissi's meta-analysis [11] concluded that the transconjunctival approach should be considered superior not only because scarring is concealed in the interpalpebral conjunctiva but also because it is associated to a statistically significant lower incidence of ectropion with respect to the subciliary approach. The authors acknowledged however that it was accompanied by a higher incidence of entropion [6,17,[20][21][22][23][24][25]. The higher incidence of entropion that was noted could be explained by the fact that the posterior lamella, which is made up of the conjunctiva, the tarsal plate, and the eyelid retractors of the inferior palpebra, was dissected.…”

Canthopexy Evaluation: A Practical Tool for Objective Efficiency Evaluation

“… 2 After reading with great interest, the manuscript by Botti et al entitled “Dynamic Canthopexy” Drill Hole Canthal Repositioning,” we successfully developed a tool for the efficiency evaluation of any canthopexy technique. 3 …”

“…The measurements were made before and after surgery was performed according to Botti's technique. 3 Before surgery, 0.9% physiological solution was injected into the bulbus until reaching the physiological tension and a steel eye protector was positioned. For the quantification, an Ethilon 3.0 suture (Ethicon Inc, Sommerville, NJ, USA) was placed as a traction thread directly through the midpoint of the inferior tarsus.…”

“…2 After reading with great interest, the manuscript by Botti et al entitled "Dynamic Canthopexy" Drill Hole Canthal Repositioning," we successfully developed a tool for the efficiency evaluation of any canthopexy technique. 3 For the evaluation, a dynamometer (A05L, WeiHeng, Guangzhou, China) has been used on 10 Caucasian fresh cadaver heads (5 females) to evaluate the force distribution at the level of the lower tarsus. The measurements were made before and after surgery was performed according to Botti's technique.…”

“…4 In addition, the use of force evaluation could be further expanded to evaluate the efficiency of other surgical techniques because it enables quantitative measurements of results in comparison to the subjective evaluation made by patients themselves, which has major limitations. 2,3,5 After validating the procedure on cadavers, the authors have successfully tested the validity of the tool also in patients. However, in our opinion, we do not believe the quantitative evaluation with a dynamometer can add benefits to any kind of canthopexy surgery but can definitely be used as a standard tool in the evaluation process of novel canthopexy techniques.…”