Traumatic Telecanthus and Posterior Lacrimal Crest Avulsion in a Six-Year-Old Child

Abstract

Pediatric facial fractures are uncommon, especially orbital fractures, which can be unnoticed in 30% of the cases. Any delay regarding either diagnosis or treatment implies the risk of long-term sequels. Limited data exists concerning craniofacial fractures in children, especially the ones compromising the orbital substructures. Distribution varies upon several series; however, there is inexistence of literature regarding specific and isolated fractures of the lacrimal skeletal system. Injuries to the medial orbital wall canthal tendon can lead to disinsertion/ruptures of the medial canthal tendon. A canthopexy is the most indicated treatment to restore the original canthal position and the re-establishment of palpebral normal function. This paper's purpose is to present an isolated posterior lacrimal crest fracture/avulsion case secondary to a high-energy trauma involving a 6-year-old girl and present an exhaust literature revision.

Post-traumatic Telecanthus Induced by a Missed Diagnosis of Avulsion Fracture of the Medial Canthal Tendon

“…The posterior limb inserts into the posterior lacrimal crest. This posterior limb is the weakest component of the MCT; consequently, sufficient energy applied to the eyelid results in the avulsion of the posterior limb with relative ease 7. In the absence of severe midface injury, MCT insertion loss due to bone avulsion or tendon rupture can be sufficient to induce post-traumatic telecanthus.…”

“…This posterior limb is the weakest component of the MCT; consequently, sufficient energy applied to the eyelid results in the avulsion of the posterior limb with relative ease. 7 In the absence of severe midface injury, MCT insertion loss due to bone avulsion or tendon rupture can be sufficient to induce post-traumatic telecanthus. Since such cases do not accompany fractures of the NOE complex, it is easy to overlook the possibility of post-traumatic telecanthus and miss the initial diagnosis.…”