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.
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 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.
The medial canthal tendon would require full detachment with transnasal canthopexy to accurately restore the medial canthus.