Telecanthus results from medial canthal tendon (MCT) disruption, which can result from traumatic naso-orbito-ethmoid (NOE) fractures. Several methods, using different anchoring materials, incision approaches or fixation positions, have been proposed for MCT reconstruction.

A new study published in the Journal of Plastic, Reconstructive & Aesthetic Surgery evaluated and reported outcomes of treatment of MCT disruption using ipsilateral transnasal medial canthopexy with a Y-V approach.

In this study, seven patients with traumatic NOE fractures underwent ipsilateral transnasal MCT fixation with Y-V epicanthoplasty. The length ratio—defined as the length of the affected side divided by that of the normal side—was calculated preoperatively and postoperatively. A modified Y-V epicanthoplasty incision was made, after first marking the site in the apex of the caruncular fornix. The nasal wall was exposed and the MCT was accessed carefully; bulky MCT tissue was trimmed. The lacrimal bone was ground using a bur, creating a concave shape to reposition the MCT, and two holes were drilled into the ipsilateral lacrimal fossa and frontomaxillary process. The MCT was fixed to the frontomaxillary process using a no. 2 transnasal wire, which was secured by a 6-mm screw. Thereafter, the Y-V epicanthoplasty was repaired using 5.0 nylon.

It was noted that the preoperative length ratio was significantly lower than the postoperative length ratio. Moreover, no major complications were reportedduring an average, 13 months of follow-up.

In inference, it was stated that ipsilateral transnasal wiring fixation with Y-V epicanthoplasty is a useful and adequate method for MCT reconstruction after NOE fractures, without remarkable complications.

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020 Jan 21. pii: S1748-6815(20)30025-5. doi: 10.1016/j.bjps.2020.01.007.