Abstract: : Purpose: We used the Lactosorb® Office fixation kit for correction of post-traumatic medial canthal dystopia to provide secure bony fixation with minimal complications. Methods: Two patients presented with downward shift of medial canthus as a result of scarring following trauma. A dacryocystorhinostomy (DCR) type incision was used to expose the medial canthal tendon Medial canthal z-plasty for MC dystopia (Fox 1976) Create z-plasty incision incorporating anterior crus of MCT into lower limb of Z. Dissect MCT from lacrimal sac, undermine flaps. Transpose flaps and resuspend MCT in higher position with suture to periosteum over frontal process of maxilla
1. Waardenburg PJ : A new syndrome combining developmental anomalies of the eyelids, eyebrows and nose roots with pigmentary defects of the iris and head hair and with congenital deafness Medial canthal z-plasty — for MC dystopia (Fox 1976) Create z-plasty incision, incorporating anterior crus of MCT into lower limb of Z (Figure 12). Dissect MCT from lacrimal sac, undermine flaps; Transpose flaps and resuspend MCT in higher position with suture to periosteum over frontal process of maxilla; Close incisions Figure 12 Medial canthal tendon (MCT) laxity is a common condition, usually age related and often causing symptoms of epiphora, discharge, irritation, and redness. MCT repair is more complicated than that of its lateral counterpart because of the intimate relation with the canaliculus (Fig 11) There is evidence of left medial canthal dystopia, telecanthus, esotropia, and hypoglobus. Photo courtesy of Drs. Nahyoung Grace Lee and Victor Liou For a patient with suspicion of injury to the medial canthal tendon, a complete ocular exam to check for any kind of globe injury is first necessary
Medial canthal tendon rupture results in canthal dystopia, increased intercanthal distance, and loss of palpebral angle.1Prevailing tendon reinsertion methods include transnasal wires and screws but have been reported to have a high failure rate, and are often complicated by medial canthal drift, wire extrusion, and contralateral orbital bone fracture under transnasal wire pressure.1, Dystopia canthorum results in the canthi being spaced widely apart, though the pupils and the rest of the eyes are set at a normal distance. The medial canthus is also susceptible to the growth of cancerous tumors Right meibomian gland dysfunction (eye condition) Right upper eyelid concretion. Sensory disorder of eyelid. Sensory disorder, eyelid. ICD-10-CM H02.89 is grouped within Diagnostic Related Group (s) (MS-DRG v38.0): 124 Other disorders of the eye with mcc. 125 Other disorders of the eye without mcc The medial palpebral commissure (commissura palpebrarum medialis; internal canthus) is prolonged for a short distance toward the nose, and the two eyelids are separated by a triangular space, the lacus lacrimalis
Achieving secure bony fixation of medial canthus is a challenge. We used a resorbable poly-L-lactic acid-polyglycolic acid screw (LactoSorb office fixation kit) in 5 cases: 2 with traumatic medial canthal dystopia, 1 with scleroderma and orbital fat atrophy causing malapposition of the medial canthus to globe, and 2 with invasive medial canthal tumors necessitating subtotal medial orbital.
The medial canthus has origins at the anterior and posterior lacrimal crests that fuse temporal to the lacrimal sac, enveloping the lacrimal sac. The medial canthus then divides into upper and lower segments that attach to the tarsus of the upper and lower lid When the lateral canthal angle is lower than the medial canthal angle, this is termed an anti-mongoloid slant. An excessive upward slant of the lateral canthal angle is known as a mongoloid slant. While traumatic lateral canthal dystopia and syndromes can account for these alterations, normal variants are more common The lateral canthus is the outside corner of the eyes, where the upper and lower eyelids come together. The outside corner of the eyelid, is normally about 1-2 mm higher than the inside corner [medial canthus] of the eye in caucasians, and sightly higher than that in Asians. When it is lower, it gives the eye a sad or tired look that you describe Reconstruction of the medial canthal area of the eyelids provides a number of challenges because of the complex anatomy which includes the junction of the upper and lower eyelids, glabella, and upper nasal side wall Telecanthus is produced by an abnormal insertion or abnormally length of the medial canthal tendons. Telecanthus may occur in isolation or in association with blepharophimosis. Telecanthus is often associated with many congenital disorders such as Down syndrome, fetal alcohol syndrome, Cri du Chat syndrome, Klinefelter syndrome, Turner syndrome.
Traumas resulting from naso-orbitoethmoidal fractures and tumor surgery of the medial canthal region may cause orbital dystopia.A variety of techniques with many disadvantages, such as detachment and high cost, has been described for reattachment of medial canthal tendon.We present a new technique, namely, unitransnasal canthoplasty, which is easy to apply, cheap, and reliable Complications from radiation therapy included skin breakdown over the mesh (9/14 patients) with nasocutaneous fistula, medial canthal tendon dystopia (2/14 patients), and corneal perforation in a patient with recurrent disease. Despite removal of the tear drainage system, only 7 of 14 patients reported epiphora
Telecanthus, or dystopia canthorum, refers to increased distance between the inner corners of the eyelids (medial canthi), while the inter-pupillary distance is normal. This is in contrast to hypertelorism, in which the distance between the whole eyes is increased. Telecanthus and hypertelorism are each associated with multiple congenital disorders.. Medial canthal dystopia often is amenable to repair during major craniofacial reconstruction because of the excellent exposure. Lateral canthal dystopia also can be repaired at this time, but other associated deformities such as maxillary hypoplasia may need to be repaired in staged procedures Abstract. Medial canthal dystopia with canalicular obstruction is a common presentation following injury to the medial canthal region. The patient also developed severe medial canthal dystopia with inadequate lower fornix, after soft tissue coverage of the anterior maxillary wall (Figure 3C). An upper to lower eyelid transpostion flap or Tripier flap was used to repair the lower eyelid and creat a lower fornix for ocular prothesis support (Figure 3D)..
medial canthal tendon dystopia • naso-orbital + loss of bone. 10 binary noe classification • a. mct attached! • b. mct not attached! operative approach • 1. bicoronal • 2. through the laceration • 3. anterior ethmoid approac `Medial Canthal Tendon and Lacrimal Apparatus frequently injured `May extend into: `Orbital Dystopia `Chronic Maxillary Sinusitis (4-7%) `Scarring `Ectropion `Problems With Mandible Motion `Enophthalmos (3%) `Soft Tissue Descent With Loss of Malar Prominenc Repair of the lax medial canthal tendon. Accepted 2002 Sep 18. Medial canthal tendon (MCT) laxity is a common condition, usually age related and often causing symptoms of epiphora, discharge, irritation, and redness. MCT repair is more complicated than that of its lateral counterpart because of the intimate relation with the canaliculus (Fig 1 Canthal dystopia (for example, down-sloping outer canthi: 'anti-Mongoloid slant' (Figure 2B) Punctal shape, for example, ring annulus or 'slit'/'comma' configuration (Figure 2C) Punctal position. had ptosis, hypertropia and medial canthal dystopia (figure 4). Visual acuity of the right eye was 6/6 and no perception of light in the left eye. Indirect ophthalmoscopy revealed normal findings in the right eye and features of optic atrophy in the left. Penetrating injuries to the eye are common durin
. In conclusion, the use of michroanchor system for medial canthopexy can be considered an easy and effective option for treatment of medial canthal dystopia Figure 94-8 A patient had an obvious cicatricial left medial canthal dystopia as a result of trauma. A, Primary repair did not address the reconstruction of the critical deep portion of the medial canthal tendon. B, The same patient as in A after left medial canthoplasty and anterior lamella reconstruction with a skin graft Medial canthus: Position, laxity, dystopia, scarring, webbing; Lateral canthus: Position, dystopia, laxity, scarring, webbing; Lower eyelid distraction test; They also supply the medial canthal region of the medial upper and lower lids. Sensory Nerves. The three primary sensory nerves of the forehead and brow are the supraorbital nerve, the.
At 3 weeks follow-up, the left eye had ptosis, hypertropia and medial canthal dystopia . Visual acuity of the right eye was 6/6 and no perception of light in the left eye. Indirect ophthalmoscopy revealed normal findings in the right eye and features of optic atrophy in the left. Download figure; Open in new tab. In those patients who underwent medial periosteal canthopexy, another periosteal flap was made vertically above the medial canthal ligament and the anterior glabella (Figures 1C and 1D). The tunnel for the flap transposition passed between the orbicularis muscle and the medial canthal ligament to preserve the tear ducts lateral canthal dystopia, rounding of the lateral canthal angle, and ectropion (Fig. 1). Retracted lower eyelids are both cosmetically unap-pealing and functionally problematic to many patients. Clinical symptoms can include any or all of the following: chronically dry eyes, redness, foreign body sensation, epiphora, photophobia, decreased.
This 59-year-old man was hit in the left medial canthus with a meat hook. The skin, orbicularis oculi muscle, and anterior head of the inferior horn of the medial canthal tendon were severed. The canalicular system was intact. The inferior horn of the medial canthal tendon was reattached to its stump at the periosteum using 5-0 chromic sutures Lateral canthal dystopia: This may be caused by poor positioning of the canthus or by using the wrong technique. Revision may be necessary after allowing an adequate healing period. Postoperative epiphora: This condition may be caused by edema A 31-year-old who presented 1 year after his initial injury with severe medial canthal dystopia and an anophthalmic socket with inadequate lower fornix (Fig. 5.4a): Intraoperatively, the medial canthus was totally freed and mobilized superiorly.Trans-nasal wiring was an option in this patient but it carries the risk of working on the opposite normal area
The position and shape of the lateral canthus greatly influence the aesthetic appeal of the eye. Lower-eyelid laxity and lateral canthal dystopia are common signs of facial aging and of congenital, iatrogenic, and posttraumatic conditions; the practitioner must address these deformities to achieve a pleasing eye shape Dystopia canthorum (canthus dystopia, telecanthus).This was first described by van der Hoeve in 1916 in association with blepharophimosis (125).It refers to the lateral displacement of the medial canthus (internal canthus) and inferior lachrymal ducts with the punctate opposite the cornea, toward the limbus
. Arrow demonstrates position of the apex of the lateral canthus. Figure 4. Lateral dystopia of the lateral canthus after lateral canthotomy, shown in the resting position without placing traction on the eyelid. Figure 5 This position results from normal anatomical and physiological factors: the medial and lateral canthal tendon integrity, normal orbicularis tone and attachments, normal pliable skin, and a normal tarsal plate. If there is a disruption of any of these structures, lower eyelid retraction, canthal dystopia, or ectropion may occur
• Lateral canthal dystopia • Enophthalmos (increased orbital vol) • Trismus (impinges coronoid) If in the medial canthus, doc will do probing and Irrigation -Gauze and saline to clean the wound well -Bowman probe, 3cc Syringe, cannula, BSS or other solution . Topic the canthus and firms the lower eyelid ( Fig. 23.11).11 23.5.2 Scleral Show and Canthal Dystopia Excess skin resection, postoperative cicatricial lid retraction, and unrecognized negative vector (high myopia, exophthalmos, and malar hypoplasia) are factors that may complicate canthal malposition correction. Failure to neutralize vertical. It can present as nodular, ulcerative, chronic dermatitis, atypical nevi etc. Baker HE (5) reported a case of BCC that presented as ectropion, then entropion, and finally medial canthal dystopia. An inflammatory mass with watering in our case resulted in erroneous diagnosis, a pigmented ulcer which developed later again mislead us from thinking. Considered by some to be one of the most versatile oculoplastic surgical procedures, canthoplasty is done to correct a variety of eyelid conditions including ectropion, entropion, lateral canthal dystopia, horizontal lid laxity, lid margin eversion, lid retraction and to improve one's cosmetic appearance Telecanthus is the main eyelid abnormality caused by lateral displacement of the medial canthus. Lateral displacement of the punctum relative to the medial canthus occurs in Type I Waardenburg's syndrome. This is referred to as dystopia canthorum. Type II Waardenburg's syndrome is distinguished FROM type I by the absence of dystopia canthorum
Orbit: lateral canthal dystopia (upward), epicanthal folds, hypotelorism Ears, low set, HL Oropharynx - macroglossia, Maxillary hypoplasia, microgenia, type 3 malocclusion, lower lip hypotoni
• Lateral canthal dystopia • Dysesthesia of cranial nerve V2 - Ipsilateral teeth and gums • Trismus and malocclusion - Bony dislocation leading to direct impingement of coronoid process • Inferior or lateral rim step-off - Dislocation of the ZM or ZF sutures creates point tenderness and palpable separation 54 ASSESS • Visual acuity • Eyelids and periorbital regions • Extra-ocular movements • Pupillary light reactivity • Globe projection • Measure enophthalmos with Hertel's or Naugle's exophthalmometer • Vertical dystopia with clear ruler • Paresthesias • Canthal positions • Eye and ZMC symmetry in all three planes 13
Tumor recurred locally in 2 patients with a regional recurrence in a third patient. Complications from radiation therapy included skin breakdown over the mesh (9/14 patients) with nasocutaneous fistula, medial canthal tendon dystopia (2/14 patients), and corneal perforation in a patient with recurrent disease basal cell nevus syndrome: [MIM*109400] a syndrome of myriad basal cell nevi with development of basal cell carcinomas in adult life, odontogenic keratocysts, erythematous pitting of the palms and soles, calcification of the cerebral falx, and frequently skeletal anomalies, particularly ribs that are bifid or broadened anteriorly; autosomal. One more detail to keep in mind is the intercanthal distance and level of attachment of the medial and lateral canthal tendons. Epker et al. 1980 suggested that this method is more aesthetic, and function of the lacrimal sac is better when dystopia of the medial canthal tendons or telecantism does not exist -- Types Of Scissors Scissors Length -- Scissors Caliber -- Scissors Tips -- Scissors Blade Design -- Scissors Cutting Motion -- Cutting With Scissors (You Learned this as a Child) -- Retraction and Exposure -- Fingers As Retractors -- Skin Hooks -- Forceps -- Dissection Technique -- Retractors -- Hemostasis -- Preoperative Considerations.
Lateral canthoplasty may be considered as one of the most valuable oculoplastic surgical procedures to correct lid abnormalities. The indications include ectropion, entropion, lateral canthal dystopia, horizontal lid laxity, lid margin eversion, lid retraction with or without soft tissue deficiency, paralytic lagophthalmos and aesthetic improvement type 1 — an autosomal dominant form caused by mutation in the transcription factor gene PAX3, and additionally characterized by wide bridge of the nose due to dystopia canthorum. Waardenburg syndrome type 1 . Medical dictionary. type 2 — an autosomal dominant form similar to type 1, but lacking dystopia canthorum Exophthalmos, Dystopia Eyelid malposition due to incorrect positioning of the medial canthal tendon is a frequent complication of displaced NOE fractures. It is not a typical complication of skull base/cranial vault fractures. Ptosis could also be a result of neurologic injury. In such cases, medical treatment is required. 9. Fractures.
(5) This report describes the characteristics and treatment of a syndrome in which the predominant ophthalmic defect is a congenital malposition of the medial canthal tendon. (6) A unique case of anatomically corrected malposition of great arteries with a bilateral absence of a complete subarterial muscular infundibulum is presented Large basal cell carcinoma. Medial canthus Mohs' defect. Medial canthus Mohs' defect. Button. After glabellar flap repair. After glabellar flap repair. WARNING Some photos may be explicit. All clinical photographs are actual patients of Dr. Klapper There was 2 mm of downward dystopia of the right lateral canthal angle. There was 1+ disk pigmentation of the cutaneous surface of the right upper lid and right lateral canthal region. The eyelid margin to corneal reflex distance #1 measured -0.5 mm, right eye, and 3.5 mm, left eye
Medial Wall Plate Universal Orbital Floor Plate enopthalmos and ocular dystopia. The postbulbar constric-tion of the bony orbital cavity is often difficult to reconstruct with bone grafts alone. Internal orbital plates provide stable support for volumetric correction by spanning the middle section of the inferomedial or medial internal orbit. Extraocular motility was full bilaterally. There was no globe dystopia or lagophthalmos. A 2.5 x 3.5 cm, tender, firm, raised mass with overlying skin hyperpigmentation was present inferior to the medial canthus on external examination of the right eye (Figure 1). There was no crepitus or fluctuance on palpation of the lesion. No mucous or. Figure 4.8. A: Medial canthal ligament injury. Medial canthal ligament (orange) is shown anchored to the bony central fragment. The central fragment lies at the junction of the frontal process of maxilla and inferomedial orbital rim. B, C, and D: Medial canthal ligament injury. Manson classification