Medial canthopexy of old unrepaired naso-orbito-ethmoidal (noe) traumatic telecanthus

Introduction Traumatic telecanthus resulting from injuries to the naso-orbito-ethmoidal (NOE) complex is a difficult deformity to treat and involves both esthetic and functional aspects. Delayed or inadequate primary treatment often results in scarring and secondary deformities that are severe and make them extremely problematic to correct. The intricate anatomy of this area makes NOE injuries one of the most challenging areas of facial reconstruction. Several techniques were described to reconstruct the medial canthal tendon (MCT) and repair the telecanthus deformity. Transnasal wiring remains the gold standard. However, the procedure is technically difficult. It necessitates wide exposure sufficient to allow transverse passage of wires through bony fenestrations deep within the orbit, and involves dissection of the contralateral orbit. Aim This study proposes a minor modification to simplify transnasal-wiring technique in the difficult cases presenting with telecanthus following unrepaired NOE fractures. Patients & methods The study included 13 patients (11 males and 2 females) presenting with telecanthus, at least six months after sustaining NOE fractures. Transnasal canthopexy was the fundamental step in reconstruction. Two wires held independently the anterior and posterior limbs of the MCT to ensure an adequate grip. They were delivered in a single pass through a single hole instead of two to avoid weakening of the thin lacrimal bones. The wires were then secured to a titanium mesh fixed to the contralateral medial orbital rim to guarantee a stable fixation. Results The technique restored the normal canthal position along the lacrimal crest. Good functional and esthetic results are reported based on the measurement of pre- and postoperative intercanthal & canthal–midline distances over a period of 2-years, with an average follow-up period of 12 months. Conclusion The results reveal the simplicity and reliability of this technique in restoring palpebral shape and intercanthal distance without any recoded functional complications throughout the follow-up.