Traction Applying Technique on Bicanalicular Crawford Silicone Tube to Overcome the Notching Deformity After Lacrimal Canalicular Repair

Abstract

Lower eyelid avulsion injury with lower canalicular laceration generally occur just medial to the punctum with insufficient skin remnant for repair causing tension on repair margins. The inevitable blinking force, along with the tension widens the repair margin, resulting in an aesthetically challenging notch at the medial lower lid. The authors attempted to minimize this notching deformity with a traction applying technique on bicanalicular silicone tube. Fifteen patients were enrolled and divided into 2 groups: the experimental group with 10 patients which received the traction technique, and the control group with 5 patients which the traction technique was omitted. Each end of the bicanalicular silicone tube was intubated through both puncta and the lacerated canaliculus. No canalicular anastomosis was performed. The tube ends were retrieved through the nostril, followed by medial canthal tendon, orbicularis oculi muscle, and skin repair. The tube ends were pulled to create a tension on the loop, until upper and lower puncta apposed each other, creating a dimple in the medial canthal area. The tube ends were tied and anchored at internal valve of the nostril to maintain the traction tension. Medial lower lid notching (>2 mm width), epiphora, and conjunctival injection were evaluated and compared in the 2 groups. Patients with traction technique showed symmetric medial canthal angle and minimized lower lid notching deformity when compared with the control group (P = 0.025). No conjunctival injections and epiphora were observed in either group. Symmetric and aesthetically satisfactory results were achieved by traction applying technique on bicanalicular silicone tube.

Effect of Multichannel Convolutional Neural Network-Based Model on the Repair and Aesthetic Effect of Eye Plastic Surgery Patients

“…In addition, the incidence of complications was considerably lower in the observation group (13%) than in the control group (28%) ( P < 0.05), indicating that reasonable and effective pouch surgery can alleviate the occurrence of complications after surgical treatment and improve the safety of surgery. This was consistent with a number of clinical research results, and the symptomatic degree of surgical method has a certain impact on the outcome of surgical treatment and the occurrence of postoperative complications [ 27 – 29 ]. Therefore, accurate examination and surgical method design is the pursuit of various clinical surgical treatment and is also very important to improve patient satisfaction, especially in the cosmetic and plastic surgery industry.…”

“…In addition, the incidence of complications was considerably lower in the observation group (13%) than in the control group (28%) (P < 0:05), indicating that reasonable and effective pouch surgery can alleviate the occurrence of complications after surgical treatment and improve the safety of surgery. This was consistent with a number of clinical research results, and the symptomatic degree of surgical method has a certain impact on the outcome of surgical treatment and the occurrence of postoperative complications [27][28][29]. Therefore, accurate examination and surgical method design is the pursuit of various clinical surgical treatment and is also very important to improve indicates that the pouch degree, lower eyelid skin wrinkles, and skin gloss score of patients in the two groups were significantly improved compared with those before operation (P < 0:05); "#" indicates that the pouch degree, lower eyelid skin wrinkles, and skin gloss score of patients in the observation group were better improved after treatment compared with those in the control group (P < 0:05).…”

Periorbital Soft Tissue Trauma

“…Stents are most commonly removed after 3 months, although this may be safely extended to a period of 4 to 6 months depending on the extent of the trauma and subsequent repair. 11,13,24 Crawford stents may be removed from within the nares with cooperation from the patient if the stent can be located and cut above the knot. If the stent cannot be visualized endonasally, it may also be removed from the puncta.…”

“…Indirect injuries are also more commonly associated with extensive injuries elsewhere in the orbit. Although these etiologies vary significantly depending on geographic location and acute care setting, indirect injuries appear to be more common, 13,24,25 although one large retrospective review also found that direct injuries occur with comparable frequency. 26 When there is a suspicion for canalicular injury, it is important to identify any canalicular dehiscence precisely for repair (►Figs.…”

“…7,11 However, newer innovations in techniques, such as applying lateral traction with the Crawford tube, may reduce the need for doing so without increasing a risk of complications. 24 Superficial lacerations involving the canaliculus may then be repaired with simple closure of skin overlying the stent. For deeper lacerations or avulsed wounds involving the medial canthal tendon, this should be reconstructed with a traction suture reattaching the posterior reflection of the tendon to its anatomical position at the periosteum of the posterior lacrimal crest.…”