External Dacryocystorhinostomy and Transnasal Canthopexy

Abstract

Combined dacryocystorhinostomy-transnasal canthopexy surgery with superior and posterior enlargement of the bony window avoided crossing of the wires and flaps and achieved a high success rate in the reconstruction of the lacrimal drainage pathway. This technique proved to be effective in the treatment of posttraumatic telecanthus with nasolacrimal duct obstruction.

Transnasal Medial Canthopexy Supported with Autogenous Bone Graft: A New Method for Repair of Traumatic Telecanthus

“…[26][27][28] This carries the risk of bone in-fracture from pressure exerted from the tied wire, leading to subsequent bone fragmentation combined with lateral canthal drift and relapse of telecanthus. 5,[29][30] In recognition of these limitations, a variety of fixation materials have been proposed, such as the use of a micro-plate 22,[27][28] or titanium mesh, 26 to allow adequate anchoring of the MCT to the contralateral medial orbit to obtain more secure fixation and prevent subsequent bone fragmentations. Nevertheless, these techniques are also associated with some limitations, such as the possibility of plate exposure, foreign body reaction, and the risk of secondary infection.…”

“…31 In order to address these problems, in the present study, we performed a single hole in the contralateral medial orbital wall instead of 2 holes to minimize any possibility of further bone fragmentation that resulted from multiple drilling as suggested by several authors. [26][27][28] The wire holding the MCT was then delivered through this hole in a single pass to the contralateral side and secured to a small bone graft by passing the wire through 2 holes in the graft in a button-like fashion. Then the wire end is pulled again to the affected side through the same hole using the trocar and the 2 wires ends are tightly twisted after setting the MCT posterior to the lacrimal crest.…”

“…The downside of the transnasal wiring standard technique is the double drilling through and tightening of the wires over the contralateral thin medial orbital bones to securely fix the MCT. 26–28 This carries the risk of bone in-fracture from pressure exerted from the tied wire, leading to subsequent bone fragmentation combined with lateral canthal drift and relapse of telecanthus. 5,29–30…”

“…Ozyazgan 27 successfully performed a transnasal fixation of the medial canthus by passing couple of wires through only one drill hole and securing them strongly over a titanium microplate on the opposite side. In 2014, Sales-Sanz et al 28 advocated the use of transnasal wiring technique through passing the wires, engaging the MCT, into the central holes of a 4-holed 1.7-mm microplate placed on the contralateral orbit.…”

“…8,12,25 The downside of the transnasal wiring standard technique is the double drilling through and tightening of the wires over the contralateral thin medial orbital bones to securely fix the MCT. [26][27][28] This carries the risk of bone in-fracture from pressure exerted from the tied wire, leading to subsequent bone fragmentation combined with lateral canthal drift and relapse of telecanthus. 5,[29][30] In recognition of these limitations, a variety of fixation materials have been proposed, such as the use of a micro-plate 22,[27][28] or titanium mesh, 26 to allow adequate anchoring of the MCT to the contralateral medial orbit to obtain more secure fixation and prevent subsequent bone fragmentations.…”