Management of the delayed traumatic medial telecanthal deformity

Abstract

Background: The normal shape of the medial canthus is a very important aesthetic and functional determinant of the eyes. Disruption of the medial canthal ligament (through trauma or cancer resection, for example) can lead to medial telecanthal deformities, including shortened palpebra, obtuse-angled medial canthi with infraplacement, increased intercanthal distance, and an absent naso-orbital valley. Objectives: The authors describe the successful application of microscrew and microplate fixation for medial canthoplasty. Methods: Thirty-eight patients (38 eyes) with unilateral medial telecanthal deformity were included in this series. For 31 patients, a self-tapping, titanium, low-profile head microscrew was propelled into the solid bone on the posterior aspect of the anterior lacrimal crest at the estimated attachment position of the medial canthal ligament, without a predrilled hole. For the remaining patients, four required placement of a microplate into which the wire could be affixed and three required autologous fascia lata graft injections into the soft tissue because of prior loss. Preoperative and postoperative measurements of each patient's lateral displacement distance were recorded and compared. Results: The patients corrected with microscrews only were divided into three preoperative groups. The patients in group 1 had a displacement distance between 4 mm and 6 mm (seven patients); group 2, between 7 mm and 9 mm (20 patients); and group 3, more than 9 mm (four patients). Postoperative lateral displacement measurements showed that the displacement distance was less than or equal to 2 mm in 27 patients, about 3 mm in one patient, and about 5 mm in the remaining three patients. Of the entire series, the majority (84.2%) of the patients were successfully corrected, with a difference in the canthal distance between their two eyes of less than or equal to 2 mm. For comparison, 60.5% of the patients had a preoperative difference of 7 to 9 mm. Conclusions: Based on the outcomes obtained in this series of 38 patients, the authors' titanium microscrew and microplate approach is shown to be an excellent choice for correcting medial telecanthal deformity. The technique, when applied in appropriate cases, achieves optimal anatomic outcomes while minimizing facial incisions. © 2010 The American Society for Aesthetic Plastic Surgery, Inc.