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!
