Elbarbary Amir S, Ali Ahmed
Department of Plastic Surgery, Ain Shams University, Cairo, Egypt; El-Demerdash Hospital, Ramsis St. Cairo, Egypt.
Department of Plastic Surgery, Ain Shams University, Cairo, Egypt; El-Demerdash Hospital, Ramsis St. Cairo, Egypt.
J Craniomaxillofac Surg. 2014 Mar;42(2):106-12. doi: 10.1016/j.jcms.2013.03.003. Epub 2013 May 31.
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.
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.
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.
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.
鼻眶筛（NOE）复合体损伤导致的创伤性远内眦间距增宽是一种难以治疗的畸形，涉及美学和功能两个方面。一期治疗延迟或不充分往往会导致瘢痕形成和严重的继发畸形，使其矫正极为困难。该区域复杂的解剖结构使NOE损伤成为面部重建中最具挑战性的领域之一。已经描述了几种重建内眦韧带（MCT）和修复远内眦间距增宽畸形的技术。经鼻穿线仍然是金标准。然而，该手术在技术上具有难度。它需要足够广泛的暴露，以允许钢丝穿过眼眶深处的骨孔进行横向穿通，并且涉及对侧眼眶的解剖。
本研究提出一种微小的改良方法，以简化在未修复的NOE骨折后出现远内眦间距增宽的复杂病例中的经鼻穿线技术。
本研究纳入了13例患者（11例男性和2例女性），他们在NOE骨折至少6个月后出现远内眦间距增宽。经鼻眦固定术是重建的基本步骤。两根钢丝分别固定MCT的前后肢，以确保足够的握持力。它们通过一个单一的孔一次性穿过，而不是两个孔，以避免薄泪骨变弱。然后将钢丝固定到固定在对侧眶内侧缘的钛网上，以确保稳定的固定。
该技术恢复了沿泪嵴的正常眦位置。根据2年内术前和术后内眦间及眦中线距离的测量结果，报告了良好的功能和美学效果，平均随访期为12个月。
结果表明该技术在恢复睑裂形状和内眦间距方面简单可靠，在整个随访过程中没有记录到任何功能并发症。
