03 traumatic telecanthus

All about traumatic telecanthus. Is perfection possible?

M. Ibrahim KhanFRCSI, FCPS (Plastic Surgery)

Department of Plastic SurgeryPakistan Institute of Medical Sciences

Islamabad

Anatomy

Anatomy

Nasoethmoidal-orbital fractures- Types I & II

Types III & IV

Clinical exam

Telecanthus Swelling Nasal deformity Instability- bimanual exam Other fractures CSF leak Lacrimal drainage

Radiographic exam

Fractures isolating central fragment:

1. Frontal process-frontal bone junction2. Medial orbital fractures3. Inferior orbital rim fractures4. Nasal fractures

Treatment

No role for closed treatment

Canthal ligament attached to bone?

Problems

Getting it there

Keeping it there

Exposure

Bicoronal Lower eyelid Gingival buccal

sulcus Laceration Nasal incision

Other important steps

Adequate dissection & release Scar excision Reduction Trans-nasal wiring Fixation of fractures Ancillary procedures Canthal reattachment Soft tissue reapproximation

Trans-nasal wiring

Canthal reattachment

Fracture fixation

Summary

Early detection & intervention Good exposure Adequate release Correct vector of pull Soft tissue approximation to bone Correction of nasal deformity Has to look right on the table

Conclusion

Pleasing outcome is a realistic aim

Thank you!