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Medial Canthal Defect: Reconstructive Options

  • Chau Pham
  • Peter W. MacIntosh
  • Aaron Fay
Chapter

Abstract

Medial canthal defects range from congenital problems such as telecanthus and epicanthal folds to large defects resulting from trauma and tumor resection. The medial canthus is a small, yet complex, area that represents the confluence of several anatomic units that affect the structure and function of the ocular and lacrimal apparatus. As a result, the reconstruction of this area requires special attention and skill. The following chapter will provide a focused review of the relevant anatomy and a broad overview of the clinical entities specific to the medial canthus and offer approaches to management of more commonly encountered defects.

Keywords

Medial canthal reconstruction Medial canthus Telecanthus Epicanthus Epicanthal fold Epicanthoplasty Canthal tendon Mohs micrographical surgery Paramedian pedicle flap 

Abbreviations

5-FU

5-Fluorouracil

BTXA

Botulinum toxin A

CT

Computed tomography

MRI

Magnetic resonance imaging

References

  1. 1.
    Turvey TA, Golden BA. Orbital anatomy for the surgeon. Oral Maxillofac Surg Clin. 2012;24(4):525–36.CrossRefGoogle Scholar
  2. 2.
    Robinson TJ, Stranc MF. The anatomy of the medial canthal ligament. Br J Plast Surg. 1970;23(1):1–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Zoumalan CI, Joseph JM, Lelli GJ, Segal K, Adeley A, Kazim M, Lisman R. Evaluation of the canalicular entrance into the lacrimal sac: an anatomical study. Ophthal Plast Reconstr Surg. 2011;27(4):298–303.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Anand S, Hollingworth K, Kumar V, Sandramouli S. Canaliculitis: the incidence of long-term epiphora following canaliculotomy. Orbit. 2004;23:19–26. 32.PubMedCrossRefGoogle Scholar
  5. 5.
    Zaldívar RA, Bradley EA. Primary canaliculitis. Ophthal Plast Reconstr Surg. 2009;25:481–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Kim YS, Choi DY, Gil YC, Hu KS, Tansatit T, Kim HJ. The anatomical origin and course of the angular artery regarding its clinical implications. Dermatol Surg. 2014;40(10):1070–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Lee HJ, Won SY, O J, Hu KS, Mun SY, Yang HM, Kim HJ. The facial artery: a comprehensive anatomical review. Clin Anat. 2018;31(1):99–108.PubMedCrossRefGoogle Scholar
  8. 8.
    Foster JA, et al. Basic and clinical science course: section 7. San Francisco: American Academy of Ophthalmology; 2016–2017.Google Scholar
  9. 9.
    Lueder GT, et al. Basic and clinical science course: section 6. San Francisco: American Academy of Ophthalmology; 2016–2017.Google Scholar
  10. 10.
    Le TT, Farkas LG, Ngim RC, Levin LS, Forrest CR. Proportionality in Asian and North American Caucasian faces using neoclassical facial canons as criteria. Aesthetic Plast Surg. 2002;26(1):64–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Kennedy RH, May J, Dailey J, Flanagan JC. Canalicular laceration. An 11-year epidemiologic and clinical study. Ophthal Plast Reconstr Surg. 1990;6(1):46–53.PubMedCrossRefGoogle Scholar
  12. 12.
    Naik MN, Kelapure A, Rath S, et al. Management of canalicular lacerations: epidemiological aspects and experience with mini-monoka monocanalicular stent. Am J Ophthalmol. 2008;145(2):375–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Kim CY, Lee SY. Structural and cosmetic outcomes of medial epicanthoplasty: an outcome study of three different techniques. J Plast Reconstr Aesthet Surg. 2015;68(10):1346–51.PubMedCrossRefGoogle Scholar
  14. 14.
    Park JI, Park MS. Park Z-epicanthoplasty. Facial Plast Surg Clin North Am. 2007;15(3):343–52.PubMedCrossRefGoogle Scholar
  15. 15.
    Yoo WM, Park SH, Kwag DR. Root z-epicanthoplasty in asian eyelids. Plast Reconstr Surg. 2002;109(6):2067–71.PubMedCrossRefGoogle Scholar
  16. 16.
    Kao YS, Lin CH, Fang RH. Epicanthoplasty with modified Y-V advancement procedure. Plast Reconstr Surg. 1998;102:1835e41.CrossRefGoogle Scholar
  17. 17.
    Kim TG, Chung KJ, Kim YH, Lim JH, Lee JH. Medial canthopexy using YV epicanthoplasty incision in the correction of telecanthus. Ann Plast Surg. 2014;72(2):164–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Mustarde JC. Epicanthus and telecanthus. Br J Plast Surg. 1963;16:346e56.Google Scholar
  19. 19.
    Yoon K. Modification of Mustardé technique for correction of epicanthus in Asian patients. Plast Reconstr Surg. 1993;92:1182e6.CrossRefGoogle Scholar
  20. 20.
    Ricca AM, Kim AK, Chahal HS, Shriver EM. Nasolacrimal stents: an introductory guide. EyeRounds.org. posted January 29, 2018; Available from: http://EyeRounds.org/tutorials/Stents/
  21. 21.
    Leibsohn JM, Hahn F. Medial canthal tendon reconstruction with nasal periosteum. Ophthalmic Plast Reconstr Surg. 1992;8(1):35–40.PubMedCrossRefGoogle Scholar
  22. 22.
    Cardim VL, Bazzi K, dos Santos Silva A, e Silva MG, dos Santos FM, Salomons RL, e Silva AD, Dornelles RD. Canthopexy and tarsal reinforcement using a periosteal flap. Revista Brasileira de Cirurgia Plástica. 2013;28(1):36–40.CrossRefGoogle Scholar
  23. 23.
    Converse JM, Smith B. Naso-orbital fractures and traumatic deformities of the medialcanthus. Plast Reconstr Surg. 1966;38:147–62.PubMedCrossRefGoogle Scholar
  24. 24.
    Mustarde JC. Repair and reconstruction in the orbital region: a practical guide. London: Churchill Livingstone; 1966.Google Scholar
  25. 25.
    Tessier P. Plastic surgery of the orbit and eyelids. Baltimore: Masson; 1981.Google Scholar
  26. 26.
    McCarthy J, Jelks G, Valauri A, Wood-Smith D, Smith B. The orbit and zygoma. Philadelphia: W.B. Saunders; 1990.Google Scholar
  27. 27.
    Howard GR, Nerad JA, Kersten RC. Medial canthoplasty with microplate fixation. Arch Ophthalmol. 1992;110(12):1793–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Shore JW, et al. Repair of telecanthus by anterior fixation of cantilevered miniplates. Ophthalmology. 1992;99(7):1133–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Callahan A, Callahan MA. Fixation of the medial canthal structures: evolution of the best method. Ann Plast Surg. 1983;11:242–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Sharma V, Nemet A, Ghabrial R, et al. A technique for medial canthal fixation using resorbable poly-L-lactic acid–polyglycolic acid fixation kit. Arch Ophthalmol. 2006;124(8):1171–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Qin Y, Li D, Chen T. Management of the delayed traumatic medial telecanthal deformity. Aesthet Surg J. 2010;30(4):516–21.PubMedCrossRefGoogle Scholar
  32. 32.
    Hayano SM, Whipple KM, Korn BS, Kikkawa DO. Principles of periocular reconstruction following excision of cutaneous malignancy. J Skin Cancer. 2012;2012:438502.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Baker SR, Baker SR. Local flaps in facial reconstruction. 3rd ed. Philadelphia: Elsevier; 2007.Google Scholar
  34. 34.
    Custer PL. Transnasal flap for medial canthal reconstruction. Ophthalmic Surg. 1994;25(9):601–3. PMID 7831002.PubMedGoogle Scholar
  35. 35.
    Sciscio A, Joshi N. The transnasal advancement flap: a technique for medial canthal area defects. Orbit. 2001;20(2):141–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Mehta JS, Olver JM. Infraglabellar transnasal bilobed flap in the reconstruction of medial canthal defects. Arch Ophthalmol. 2006;124(1):111–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Ng SGJ, Inkster CF, Leatherbarrow B. The rhomboid flap in medial canthal reconstruction. Br J Ophthalmol. 2001;85:556–9.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Rajabi MT, Hosseini SS, Rajabi MB, Tabatabaie SZ. A novel technique for full thickness medial canthal reconstruction; playing with broken lines. J Curr Ophthalmol. 2016;28(4):212–6.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Jelks GW, Glat PM, Jelks EB, Longaker MT. Medial canthal reconstruction using a medially based upper eyelid myocutaneous flap. Plast Reconstr Surg. 2002;110:1636–43.PubMedCrossRefGoogle Scholar
  40. 40.
    Kim JH, Kim JM, Park JW, Hwang JH, Kim KS, Lee SY. Reconstruction of the medial canthus using an ipsilateral paramedian forehead flap. Arch Plast Surg. 2013;40(6):742–7. PMID 24286048.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Correa BJ, Weathers WM, Wolfswinkel EM, Thornton JF. The forehead flap: the gold standard of nasal soft tissue reconstruction. Semin Plast Surg. 2013;27(2):96–103.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Thornton JF. Skin grafts and skin substitutes. In: Selected readings in plastic surgery. 2004;10(1):1–24.Google Scholar
  43. 43.
    Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology. 1985;92(11):1461–70.PubMedCrossRefGoogle Scholar
  44. 44.
    Son D, Harijan A. Overview of surgical scar prevention and management. J Korean Med Sci. 2014;29(6):751–7.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Liu A, Moy RL, Ozog DM. Current methods employed in the prevention and minimization of surgical scars. Dermatol Surg. 2011;37(12):1740–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Shin TM, Bordeaux JS. The role of massage in scar management: a literature review. Dermatol Surg. 2012;38(3):414–23.PubMedCrossRefGoogle Scholar
  47. 47.
    Darougheh A, Asilian A, Shariati F. Intralesional triamcinolone alone or in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. Clin Exp Dermatol. 2009;34(2):219–23.PubMedCrossRefGoogle Scholar
  48. 48.
    Xiao Z, Qu G. Effects of botulinum toxin type a on collagen deposition in hypertrophic scars. Molecules. 2012;17(2):2169–77.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Shaarawy E, Hegazy RA, Abdel Hay RM. Intralesional botulinum toxin type a equally effective and better tolerated than intralesional steroid in the treatment of keloids: a randomized controlled trial. J Cosmet Dermatol. 2015;14(2):161–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Prodromidou A, Frountzas M, Vlachos DE, Vlachos GD, Bakoyiannis I, Perrea D, Pergialiotis V. Botulinum toxin for the prevention and healing of wound scars: a systematic review of the literature. Plast Surg. 2015;23(4):260–4.CrossRefGoogle Scholar
  51. 51.
    Zhang DZ, Liu XY, Xiao WL, Xu YX. Botulinum toxin type a and the prevention of hypertrophic scars on the maxillofacial area and neck: a meta-analysis of randomized controlled trials. PLoS One. 2016;11(3):e0151627.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Puri N, Talwar A. The efficacy of silicone gel for the treatment of hypertrophic scars and keloids. J Cutan Aesthet Surg. 2009;2(2):104–6.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Poston J. The use of the silicone gel sheeting in the management of hypertrophic and keloid scars. J Wound Care. 2000;9:10–2.PubMedCrossRefGoogle Scholar
  54. 54.
    Suetake T, Sasai S, Zhen YX, Tagami H. Effects of silicone gel sheet on the stratus corneum hydration. Br J Plast Surg. 2000;13:157–9.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Chau Pham
    • 1
  • Peter W. MacIntosh
    • 1
  • Aaron Fay
    • 2
  1. 1.Department of OphthalmologyUniversity of IllinoisChicagoUSA
  2. 2.Department of OphthalmologyHarvard Medical SchoolBostonUSA

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