Complications can include overtightening, but this is nearly impossible to do with a canthopexy and usually relaxes with a canthoplasty, Dr.
"The tendon will continue to age normally, so a canthopexy patient may require or want more tightening with a canthoplasty years down the road."
Caption: After the procedure, showing the benefits of lower lid support from canthopexy.
Caption: The after photo shows the benefits of lower lid support via canthopexy.
Because the anatomic reduction appeared to preserve the intercanthal distance and the fractured segments, and given the preoperative stability of the medial canthus bilaterally, we felt that the medial canthus did not require a formal transnasal canthopexy. An intraoperative bowstring test confirmed that the canthus was relatively intact.
During our intraoperative assessment, we used the contralateral medial canthus along with the anterior and posterior lacrimal crests, the frontoethmoid suture line, and the anterior ethmoid artery as our guide to the correct placement of our new canthus, thereby following commonly accepted techniques for transnasal canthopexy. We directed our drilling from a position posterior and superior to the lacrimal fossa on the involved side to the superior portion of the lacrimal fossa between the anterior and posterior lacrimal crests on the contralateral side, while noting the level of the anterior ethmoid artery.
We believe that a central, intact fragment that cannot accommodate the placement of a single microplate and screw is essentially a Markowitz type III fracture that most likely will require transnasal canthopexy with canthal detachment.
Reduction of the fragment into anatomic position with the intercanthal distance being preserved with plates and screws should be adequate and should obviate the need for transnasal canthopexy of the central fragment.