Late management of medial canthal deformities after naso-orbital-ethmoid fractures

Abstract

To evaluate the surgery methods and effectiveness of medial canthal deformities after naso-orbital-ethmoid fractures (NOE) and analysis the long-term results. The clinical data and following-up results from 83 patients (83 eyes), which were treated in the Department of Ophthalmology, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University from January 1999 to January 2004, were retrospectively analyzed. All the patients had unilateral medial canthal deormities after NOE fractures, and they were on operations of medial canthoplasty and fixation of the canthal ligament. Based on the severity of the canthal deformities and local scar of the area, different skin flaps were utilized for canthoplasty, such as "Y-V" flap, "Z" flap, "Mustard" method and rotation flaps. According to the fracture pattern and severity of the medial canthal tendon's injury, different medial canthopexy were performed such as suturation, fixation with titanium nail, drilling a role across the bone, and reposition the "central segment" using titanium miniplates. The surgery to repair the obstruction of the lacrimal system were accompanied with canthoplasty at the same time, while the orbital surgery for repositon of the enophthalmos was often performed at the first stage, and then the deformities of medial canthus were corrected after more than six months. The follow-up time varied from 12 to 30 months. 72 cases obtained satisfied contour of the medial canthal area, the position of the canthus was symmetry with the normal side, especially the formation of the canthal fossa. Recurrence of deformities occurred in 11 cases in six months after canthoplasty, among them 6 patients were re-operated for the second time. According to the fracture pattern and severity of the medial canthal deformity, different operative designs and canthoplasy can produce satisfied results.