PRS AAPS Oral Proofs 2016
Larry A. Sargent, MD
From the University of Tennessee College of Medicine Chattanooga, Chattanooga, Tenn.
PURPOSE: Management of the medial canthi and adjacent soft tissue in traumatic and congenital interorbital deformities are often disappointing requiring secondary canthopexies and soft-tissue revisions. The purpose of this article is to describe techniques refined over 30 years of management of the medial canthi and adjacent soft tissue in an effort to improve results and reduce revisional procedures.
METHODS: The author’s 30-year experience in the treatment of more than 650 interorbital reconstructions, 500 complex nasoethmoid orbital fractures, 54 congenital orbital hypertelorism patients, and more than 100 posttraumatic interorbital reconstructions, is the basis of the surgical techniques described.
RESULTS: The following soft techniques and principles are described: (1) wiring techniques with medial canthi reinforcement versus reinsertion, (2) the inadequacy of the simple canthopexy, (3) the amount of over reduction needed, (4) dermal fixation using the concept of progressive tension, (5) the importance of nasal height restoration, and (6) soft-tissue compression bolsters of the medial canthal area. Using these techniques revisional medial canthopexies were required in 7% of congenital deformities and 2% of traumatic deformities.
CONCLUSIONS: Successful management of traumatic and congenital interorbital deformities must include meticulous medial canthi and soft-tissue fixation and contouring that are often overlooked. Application of the surgical technologies described has enhanced aesthetic outcomes, has reduced revisional surgery, and can be the key to improving results of this complex area.