Intercanthal Distance Research Articles

Orbital and periorbital anthropometric variations and effect of age and gender on these variables

Background: The objective of this study was to identify the orbital and periorbital anthropometric variations and determine the effects of age and gender on these variables. From January 2020 to July 2020, we conducted a hospital-based, descriptive, observational study. Material and methods: Three hundred and eighty individuals of age15 years and above were included in the study. Exophthalmometric value (EV) and outer inter-canthal distance (OICD) were measured [mm] on Hertel’s exophthalmometer. Inner inter-canthal distance (ICD), inter-pupillary distance (IPD) [mm], palpebral fissure width (PFW), palpebral fissure height (PFH), marginal reflex distance 1 (MRD1), marginal reflex distance 2 (MRD2), lid crease height (LC), pre-tarsal show (PTS) and levator function (LF) were recorded using a millimeter ruler scale. Data were analyzed using a Microsoft Excel sheet. Results: Out of 380 subjects, there were 222 females and 158 males. Mean EV was 15.86 mm, OICD — 105.57 mm, ICD — 31.7 mm, IPD — 59.55 mm, PFW — 29.7 mm, PFH — 10.04 mm, MRD1 — 4.21 mm, MRD2 — 5.87 mm, LC — 8.31 mm, PTS — 4.24 mm and LF —14.66 mm. Significant sexual dimorphism was noted in five parameters; EV, ICD, IPD, PFH and MRD2 were significantly higher in males versus females. PFH was decreased while PTS was increased in individuals of more than 40 years. Conclusion: There is a significant difference between males and females in some variables, and no difference was detected in others. Age did not significantly affect a majority of the variables.

Photo-Anthropometric Study of Breadth of Eye and Intercanthal Distance Among Tribal Garo and Non-tribal Adult Bangladeshi Females of Mymensingh Zone

Background: Anthropometry provides quantitative data in identifying people having different physical characteristics in diagnosing people having craniofacial abnormality and to compare between patient and normal population. The eye is a person’s most defining feature because the shape of the eye differs from race to race, tribe to tribe and from one environment to another.Objective: To see craniofacial anthropometric differences between tribal (Garo) and non-tribal Bangladeshi females.Materials & Methods: This cross sectional, analytical type of study was conducted in the Department of Anatomy, Sir Salimullah Medical College, Dhaka, from January to December of 2015. The study subjects consist of two hundred adult Bangladeshi females of Mymensingh Zone – 100 were tribal (Garo) females and 100 were non-tribal females.Results: The mean breadth of eye from ‘distance between outer and inner canthus of right and left eye ’was higher in non- tribal female than tribal (Garo) female and was statistically significant (P<0.001) and intercanthal breadth from ‘distance between inner canthus of right and left eye’ was higher in tribal female than non-tribal female and was statistically significant (P<0.05).Conclusion: The breadth of the eye was greater in non- tribal female and intercanthal breadth was greater in tribal females.International Journal of Human and Health Sciences Vol. 06 No. 01 January’22 Page: 104-107

Transnasal Medial Canthopexy Supported with Autogenous Bone Graft: A New Method for Repair of Traumatic Telecanthus.

The medial canthus is an important structure to maintain the shape of the eye and assist in drainage of the lacrimal sac. Traumatic telecanthus is a difficult deformity to treat which involves both esthetic and functional aspects. Transnasal wiring remains the gold standard for repair of the medial canthal tendon (MCT) avulsion; however, it is often complicated by canthal drift, extrusion of wires, and in-fracture of the contralateral orbital bones from pressure by tied wires. In order to overcome traditional transnasal wiring technique pitfalls, this study proposes a transnasal wiring fixation method supported with a bone graft to treat patients presenting with telecanthus following complex nasoorbitoethmoid fractures. From December 2018 to October 2020, 12 patients with traumatic telecanthus underwent transnasal wiring fixation of the MCT supported with bone graft. The wire holding the MCT was delivered through a single hole to the contralateral side and secured to a small bone graft by passing the wire through 2 holes in the graft in a button-like fashion. Then the wire end is pulled again to the affected side through the same hole and the 2 wires ends are tightly twisted after setting the MCT posterior to the lacrimal crest. Restoration of the MCT to its normal position was achieved in all patients. There were no observed major complications. Only 2 cases of wound infection and 1 case of dacrocystitis were encountered, which settled with conservative management. The preoperative palpebral fissure width (mean: 28.33mm ± 2.188mm) was significantly lower than the postoperative palpebral fissure width (mean: 34.17mm ± 1.03mm) ( P< 0.05). This study introduces a modified technique of transnasal wiring fixation to restore palpebral shape and intercanthal distance. The proposed technique could eliminate most of the frequently observed complications of the traditional methods.

An analogy between maxillary anterior teeth dimensions measured using facial proportions and Chu proportion gauge: an in vivostudy

Background:A fine balancing of geometric concepts and artistic abilities is required while designing smiles. One of the key elements that makes up the smile frame is tooth size. The maxillary front teeth are the most noticeable in the smile arch, therefore choosing the right tooth size and positioning it in the maxilla improves both aesthetics and treatment outcomes.Aim:This study aimed to compare the dimensions of maxillary anterior teeth measured with vernier callipers and CHU proportion gauge with facial proportions such as intercanthal distance, interalar width and bizygomatic width.Materials and Methods:On a sample of 100, Facial proportions, mesiodistal width, and height of maxillary anterior teeth were recorded using digital callipers and a Chu proportion gauge. The recorded data were subjected to statistical analysis. Mean comparisons of each width were done using a t-test, ANOVA and Tukey’s Post-hoc test considering a p-value less than 0.05 to be statistically significant. Results:Mean values of the combined width of anteriors calculated using Chu gauge was 45.08, and that calculated using Vernier Callipers was 45.85. Multiplying the factor 1.47 to Inner canthal width and 1.42 to Interalar width results in the combined width of the maxillary anterior teeth. A mean difference of 0.02620 ± 0.91777 and 0.4988 ± 0.91777 exists between Inner canthal and Combined Chu’s width with a 0.04% and 0.34% error in younger and elder age populations, respectively. A mean difference of -11.4775 ± 0.91777 and -11.6039 ± 0.91777 exists between Combined mesiodistal width obtained by using Chu’s width and bizygomatic width witha 0.01% error in younger and elder age populations, respectively.Conclusions:This study reported a negligible 0.7 difference in the means of the combined width of anteriors calculated using Chu gauge and Vernier Callipers. Hence, these two methods can be used as alternatives to calculate the width of anterior teeth

The Relationship of Facial Measurements with the Mesiodistal Width of the Maxillary Anterior TeethWidth of the Maxillary Anterior Teeth

The relationship between facial measurements and the size of the maxillary anterior teeth in the Malaysian population is still a point of contention. Objective: The purpose of this study was to establish a relationship between facial measurements and the mesiodistal width of the maxillary anterior teeth (MDW), which could be used to guide the selection of anterior teeth for complete denture construction. Methods: The facial and dental measurements were obtained directly from 170 Malay adults aged between 19 to 35 who had morphologically normal permanent maxillary anterior teeth from canine to canine. The facial dimensions measured were interpupillary distance (IPD), intercanthal distance (ICD) and interalar distance (IAD). The facial dimensions were measured using a digital vernier calliper while the mesiodistal width of the maxillary anterior teeth was measured with a flexible ruler. The three facial dimensions were correlated with MDW for both genders. Results: The IPD and IAD were significantly (p&gt;0.001) larger in males (IPD: 68.30±4.24mm; IAD: 39.60±2.54mm) than in females (IPD: 65.93±3.91mm; IAD: 36.96±2.29). There was no significant correlation between any of the facial dimensions and MDW in males or females. Conclusion: For the studied population, the interpupillary, intercanthal, and interalar distances may not be used as reliable guides when determining the size of maxillary anterior teeth in complete denture construction

Facial and Eyelid Changes in Thyroid Eye Disease Are Reversed by Teprotumumab.

Background:Thyroid eye disease (TED) causes orbital soft-tissue expansion. Recent studies have suggested that brow and temple changes may also occur. Teprotumumab, a monoclonal antibody to the insulin-like growth factor 1 receptor reduces soft-tissue swelling in TED. In this study, we quantified the changes to pan facial soft-tissue volumes and eyelid position, following treatment with teprotumumab.Methods:In this prospective study, consecutive patients who were treated with teprotumumab were appraised for study eligibility. All patients had 3D facial imaging using the Vectra H2. Soft-tissue volume changes in the upper face, periorbita, temples, midface, and lower face were quantified before and after teprotumumab therapy. Furthermore, the marginal reflex distance (MRD)1, MRD2, and intercanthal distance were also measured pretreatment and posttreatment.Results:Twenty-three patients were included in the study. The mean duration of TED was 29 months (38). Following teprotumumab therapy, the mean (SD) decrease in volume for each region was 0.75 mL (0.84) in the upper face, 1.8 mL (1.3) in the periorbital region, 0.17 mL (0.5) in the temples, 1.62 mL (3.16) in the midface, and 2.67 mL (4.6) in the lower face. The mean (SD) decrease in the volume of the full face was 8.9 mL (8.7). There was also a significant reduction in MRD1, MRD2, and the intercanthal space following treatment. There was no relationship between previous steroid use and total body weight reduction and changes in facial volume.Conclusion:TED may cause significant tissue expansion across the entire face and this may be reduced following teprotumumab therapy.

Incisor- Molar Hypomineralization Phenotype Characteristics and Comparison with Amelogenesis Imperfecta: An Approach to a Differential Diagnosis

Background: Incisor-molar hypomineralization (IMH) presents various clinical characteristics that generate confusion for differential diagnosis with other enamel abnormalities such as amelogenesis imperfecta (AI). Purpose: To analyze dental, facial, and skeletal characteristics in people with IMH and compare them to those with AI in order to identify diagnostic differences between these two enamel defects. Methods: Analytical observational study. Twelve 7-to-10-year-olds with IMH and 10 8-to-49-year-olds with AI were studied. IMH was assessed according to the European Academy of Pediatric Dentistry’s diagnostic criteria, Mathu Maju’s criteria (2006), and Neeti Mittal’s phenotypic classification (2016), while Witkop’s criteria (1989) were used to analyze AI. Clinical, radiographic, facial, and skeletal analyses were performed to establish IMH phenotypes, information that was fed into an Excel® database for subsequent statistical analysis (SPSS 22.0) (p&lt;0.05). Results: Statistically significant differences were found between IMH and AI. Only patients with IA presented dilaceration, dental agenesis, and taurodontism. There are similarities regarding facial features such as facial asymmetry, increased intercanthal distance, decreased lower third, biprochelia and convex profile, and occlusal features such as molar relationship, canine relationship, and overjet. Concerning transverse relationships, micrognathism was more frequent in IMH and in vertical relationships, deep overbite was greater in IMH than in AI. Conclusions: The main differences between IMH and AI were evident in skeletal characteristics and associated dental alterations.

Facial Anthropometry Measurements Using Three-Dimensional Stereophotogrammetry Analysis Among Nigerians.

This study aimed to determine the normative facial anthropometry measurement among Nigerians using three-dimensional stereophotogrammetry analysis.This study was carried out in Lagos, Nigeria over a period of 3 years. The sample population was Nigerians of diverse ethnic groups, age 16 and above with no history of congenital or acquired craniofacial deformities.A total of 452 subjects participated in the study with 56.2% males and 43.8% females. Most of the participants were between the ages of 25 to 49 (54.4%), 40.7% were less than 25 years of age and only 4.4% were more than 50 years old. The mean body mass index (BMI) for males was 22.7 and 23.4 for females. Mean values of upper facial height, midfacial height, lower facial height, intercanthal distance, interpupillary distance, upper facial width, and lower facial width are 69.13 ± 5.91, 49.89 ± 3.56, 67.85 ± 6.12, 35.19 ± 3.20, 67.04 ± 3.67, 139.43 ± 7.11, and 124.29 ± 9.72 mm, respectively. The upper facial height, commissure width, upper lip length, and lower jaw width were significantly affected by age, while the BMI of an individual was a determinant of the interpupillary distance, facial width, and lower jaw width.This study demonstrated that there was a statistically significant difference in the facial dimensions of males when compared to females across all ages among the study population. The authors also observed that age and BMI are significant predictors of variations in some of the measurements.

Correcting Wide Alar Base and Flare With Combined Sill and Alar Excision in Asian Patients.

Obvious scar and deformities are commonly observed with incision anterior to the alar-facial groove in alar excision surgery. The authors explored modified sill and alar excision to correct wide alar base and flare synchronously and decreased incident of unacceptable scar and deformities in Asian patients. The authors conducted a retrospective cohort study including 52 consecutive patients undergoing this surgery. Contrary to previous studies, the incision for alar excision was located in the alar-facial groove and was closed by intracutaneous suture. Scars were assessed with visual analog scale and the Stony Brook Scar Evaluation Scale. Ratio of the interalar distance to intercanthal distance, nostril shape, and nostril symmetry was recorded. The mean follow-up time was 18 months. Visual analog scale results showed 50 patients (96.2%) reported unnoticeable scar and 2 noticeable but acceptable scar. Stony Brook Scar Evaluation Scale results indicated 49 patients (94.2%) with good scar outcomes and 3 (5.8%) with moderate scar outcomes. The mean ratio of interalar distance to intercanthal distance reduced significantly from preoperative 1.10 to postoperative 1.02. The frequency of horizon-shaped nostrils changed from preoperative 16 cases (30.8%) to postoperative 2 cases (3.8%). The frequency of the pear-shaped (preferred shape) nostrils improved from preoperative 15 cases (28.8%) to postoperative 26 cases (50.0%). The frequency of symmetrical nostril shape improved from preoperative 36 patients (69.2%) to 42 (80.8%). There were no patients with complications like alar deformities, and patients' dissatisfaction. When performing sill and alar excision in Asian patients, the authors recommended a modified approach with the incision for alar excision being placed in the alar-facial groove and closed by intracutaneous suture, which can avoid obvious scar and deformities in Asian patients.Level of evidence: Level 4.

A Cross-Sectional Study to Determine and Compare the Craniofacial Anthropometric Norms in a Selected Kenyan and Chinese Population.

Background: Craniofacial anthropometry provides essential data for diagnosis and treatment planning, with the norms for many races having been investigated. The results reveal that facial morphometry varies greatly because of geographical, ethnic, and racial variations. This study aims to gather the normative anthropometric data and compare the differences in facial morphometry between the Kenyan population and that of the Chinese. Methods: Four vertical measurements (trichion-nasion, nasion-subnasale, subnasale-gnathion, and superaurale-subaurale) and 6 horizontal measurements (zygion-zygion, exocanthion-endocanthion, endocanthion-endocanthion, pupil-pupil, alare-alare, and chelion-chelion) were obtained manually from subjects with no craniofacial abnormality. Results: A total of 180 participants (90 Kenyans and 90 Chinese) were included. Among the Kenyans, males generally had greater dimensions in comparison to the Kenyan females with the exception of the upper third, lower third, and intercanthal, and interpupillary distances. Among the Chinese, there was a significant difference between the 2 genders with the exception of intercanthal distance. All measurements were greater in Chinese males in comparison to the females. Comparison between races shows that Kenyans had greater vertical measurements with exception of the ear length for both genders. The Chinese males had increased facial width and intercanthal distance, while the Chinese females showed increased intercanthal distance compared to Kenyans. Kenyans exhibited hyperleptoprosopic-type face, while Chinese exhibited mesoprosopic-type face, with none of the 2 groups conforming to the neoclassical canons. Conclusion: Kenyans generally have greater craniofacial measurements versus Chinese, except for the facial width and intercanthal distance for males and interorbital distance for females.

Assessment of Columellar Widening with Columellar Strut Placement

Objective: The columellar strut is a frequently used technique to provide nasal tip support and projection that is commonly thought to increase columellar width. However, systematic review of the effect has not been reported in the literature. We report a quantitative evaluation of the effect of columellar strut placement on columellar width. Methods: A retrospective cohort study of changes in columellar width in base view photographs for patients who underwent primary rhinoplasty with columellar strut placement (n = 35) and the closely related septal extension graft (n = 9) and tongue-in-groove (n = 5) procedures at Mount Sinai Hospital between 2010 and 2017. The ratio of the columellar width to the intercanthal distance was used to standardize the results among patients. Comparisons were made at follow-up periods of &lt;1 week, 2 to 4 weeks, 1 to 3 months, 3 to 6 months, 6 to 12 months, and &gt;1 year of follow-up. Results: Forty-nine patients (41% female; average age of 43 ± 15 years) were reviewed. The columellar width showed a statistically significant increase for all follow-up date ranges with the exception of 1 week and 3 to 6 months post-operatively. At &gt;1 year of post-operative follow-up, the mean increase in columellar width was 8.6% (95% CI, 2.6%-14.5%, P = .0098). No statistically significant differences were noted between open versus closed procedure for all followup visits after the 1 week followup, and no significant difference if a septocolumellar stitch was placed. Conclusions: A columellar strut was demonstrated to lead to an increase in columellar width. Though the effect was modest at a 8.6% increase, this is a potential cosmetic consideration for the surgeon employing its use to provide nasal tip support and projection.

Correlation of intercanthal and interalar distance to intercanine distance for selection of maxillary ant. teeth

Background: Maxillofacial region’s reference points like interpupillary distance, intercanthal distance, interalar distance and bizygomatic width can significantly contribute toward reconstruction of two-dimensional (2D) facial profiles. Aim: To find correlation between intercanthal to intercanine and interalar to intercanine distance for maxillary anterior teeth selection. Methodology: This study was conducted at de’ Montmorency College of Dentistry/ Punjab Dental Hospital, Lahore from 29-08-2013 to 28-04-2014. Sampling technique was non-probability purposive. 200 subjects are estimated for correlation of intercanthal distance to intercanine distance and correlation of interalar distance to intercanine distance as r=0.302. Results: Out of 200 cases, 102(51%) were 20-40 years of age while 98(49%) were ranging between 41-60 years of age, mean±SD was calculated as 41.01±11.90 years, 135(67.5%) were male and 65(32.5%) were females, correlation among maxillary intercanine distance with other facial land marks shows the distance of intercanine was 37.26±3.91, it was 41.26±4.57 for interalar and 34.50+2.51 was recorded for intercanthal, the value of R2, the coefficient of determination, is 0.0893 for intercanine to intercanthal and 0.0018 for intercanine to interalar. Conclusion: We concluded that intercanthal distance to intercanine distance is more correlated as compared to interalar distance to intercanine distance in Pakistani population. Keywords: Maxillary anterior teeth, intercanthal distance, intercanine distance, interalar distance, correlation

PeriorbitAI: Artificial Intelligence Automation of Eyelid and Periorbital Measurements

To develop a deep learning semantic segmentation network to automate the assessment of 8 periorbital measurements DESIGN: Development and validation of an artificial intelligence (AI) segmentation algorithm METHODS: A total of 418 photographs of periorbital areas were used to train a deep learning semantic segmentation model to segment iris, aperture, and brow areas. These data were used to develop a post-processing algorithm that measured margin reflex distance (MRD) 1 and 2, medial canthal height (MCH), lateral canthal height (LCH), medial brow height (MBH), lateral brow height (LBH), medial intercanthal distance (MID), and lateral intercanthal distance (LID). The algorithm validity was evaluated on a prospective hold-out test set against 3 graders. The main outcome measures were dice coefficient, mean absolute difference, intraclass correlation coefficient, and Bland-Altman analysis. A smartphone video was also segmented and evaluated as proof of concept. The AI algorithm performed in close agreement with all human graders, with a mean absolute difference of 0.5 mm for MRD1, MRD2, LCH, and MCH. The mean absolute difference between graders is approximately 1.5-2 mm for LBH and MBH and approximately 2-4 mm for MID and LID. The 95% confidence intervals for all graders overlapped in most cases, demonstrating that the algorithm performs similarly to human graders. The segmentation of a smartphone video demonstrated that MRD1 can be dynamically measured. We present, to our knowledge, the first open-sourced, artificial intelligence system capable of automating static and dynamic periorbital measurements. A fully automated tool stands to transform the delivery of clinical care and quantification of surgical outcomes.

Alar Flare Preservation Using the Sandwich Technique as an Adjunct to Alar Base Reduction.

Background:Achieving an aesthetic balance and natural appearance when modifying soft tissues of the nasal tip, alae, and nostrils is fundamental to the success of rhinoplasty surgery. The present study aimed to investigate the ability of a simple “sandwich” technique combined with external alar base reduction to preserve the alar flare and achieve a natural and appealing alar contour.Methods:The study included 40 patients who reported dissatisfaction due to excessive nasal flaring. Cartilaginous grafts were harvested from the septum in cases of primary rhinoplasty. Grafts were harvested from the conchal cartilage in cases of secondary rhinoplasty to ensure adequacy of the grafts. The grafts were inserted from the alar wedge excision point along the created pocket to be “sandwiched” in the soft tissue of the alar rim.Results:The average preoperative alar flare was 35.2 mm (SD ±1.9 mm), with an average postoperative reduction of 3 mm. Difference between intercanthal distance and postoperative alar flare distance showed a mean of (−0.4 mm) (SD ±1.2 mm) and was highly significant with P < 0.05. A comparison between nasal base width and alar flare measurements was done. Difference between nasal base width and preoperative alar flare distance was (−9.2 mm) (SD ±2.6), and between nasal base width and postoperative alar flare was (−6.3 mm) (SD ±2.1). Postoperatively, overall patient satisfaction was scored 4.1 of 5.Conclusion:The use of a trapezoidal graft, in combination with external alar base reduction, markedly improves the basal view while maintaining the natural alar flare and curvature.

Experience of Two Different Techniques of Medial Epicanthoplasty with Four-Point Homologous Design: A Cohort Study.

Various methods have been introduced to eliminate the epicanthus; however, there are no clear guidelines to determine the optimal technique for epicanthus. We aimed to investigate the clinical effect of modified Z-plasty and modified Y-V flap on epicanthus and report our experience. Medical records, including photographic information and scar score, of 81 eyes of 43 patients with congenital epicanthus were collected. All patients underwent epicanthus correction surgery by the modified Z-plasty or modified Y-V flap methods with a four-point design from January 2018 to December 2019 in Shanghai Ninth People's hospital and completed a follow-up of at least 6 months. The cosmetic outcome was evaluated in terms of by photographic evaluation and scar score, and the structural outcome was assessed by intercanthal distance (ICD) and palpebral fissure length, inner canthal angle, the canthal tilt angle. The results of two surgical techniques were compared and analyzed. The cosmetic outcome of both group is good in both groups. ICD is smaller and inner canthal angle is larger in modified Z-plasty group, compared to modified Y-V flap group, respectively (P < 0.05). Patients with severe epicanthus in the modified Z-plasty group showed greater improvement in structural outcomes than in the modified Y-V flap group (P < 0.05), while those with mild epicanthus in the modified Y-V flap group showed more improvement in ICD than those in the modified Z-plasty group (P < 0.05). By 6 months, scarring in the modified Z-plasty group was more hypertrophic and obvious compared to the modified Y-V flap group (P < 0.05). Modified Y-V flap technique caused less scarring. Conversely, the modified Z-plasty technique was more efficient in shortening the ICD and increasing inner canthal angle. While modified Z-plasty reconstruction is more suitable for patients with severe epicanthus, the modified Y-V flap is more suitable for patients with mild epicanthus. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Correlation between inter inner canthal distance and occlusal vertical dimension among young adults of Dakshina Kannada population: An in vivo study

Objective methods of determining the vertical dimension of occlusion offer significant advantages because no radiographs or others special measuring devices are required. One of the objective measurement of vertical dimension of occlusion is twice the intercanthal distance. Hence this study was aimed to evaluate the correlation between the length of vertical dimension of occlusion and the length of twice the inter inner canthal distance among Dakshina Kannada population. Innercanthal and occlusal vertical dimension measurements were taken using digital vernier caliper from 60 subjects that fulfilled all criteria stated. The results were statistically analyzed. There was positive correlation between twice inner canthal distance and occlusal vertical dimension in Dakshina kannada population.

Experience of Comprehensive Three Dimensional Epicanthoplasty With Upper Blepharoplasty in Asian Patients.

To introduce the experience of comprehensive 3-dimensional epicanthoplsty with upper blepharoplasty in Asian patients. The patients who underwent comprehensive 3-dimensional epicanthoplsty with upper blepharoplasty at the Shanghai Ninth People's hospital from January 2018 to January 2019 were included in our study. The interepicanthal distance was evaluated preoperatively and 6 months after the surgery, scar visibility and patient's satisfaction were documented 6 months after the surgery. A total of 72 patients (144 eyelids) were included in this study with ages ranging from 18 to 37 years (mean, 23.83 ± 4.64 years) and follow-up duration ranging from 6 to 12 months (mean, 7.82 ± 1.92 months). All patients were female and achieved esthetically favorable results without serious complications. No patients required revision surgery showing high patient satisfaction (score, 4.4). The preoperative mean interepicanthal distance was 33.13 ± 2.25 mm and decreased to 29.28 ± 2.26 mm postoperatively showing statistical significance (P < 0.001). Twenty-nine (40.3%) patients had no visible scarring, and 42 (58.3%) patients had minimal scarring, which was accepted by the patients. The comprehensive 3-dimensional epicanthoplasty with upper blepharoplasty is a surgical technique that is easy to perform, reliable, and effective in treatment of all types of epicanthal folds except type 4 with increase intercanthal distance, less visible scar, and high patient satisfaction in Asian patients.

Medial canthopexy using mini-screws &/or micro plates for the surgical treatment of post traumatic telecanthus associated with naso-orbito-ethmoidal fractures

BackgroundThe normal bony insertion of the medial canthal tendon can be disrupted after trauma, as a result of ablative surgery or as a consequence of subperiosteal detachment during a craniofacial surgical procedure. Medial canthoplasty is required to avoid telecanthus following these events. Several surgical techniques have been described to reattach the tendon to the posterior lacrimal crest. The techniques of transnasal wiring had been used widely to reconstruct medial canthal tendon. However, some surgeons have preferred the use of ipsilateral techniques that include the nylon anchor suture, the stainless-steel screw and/or miniplates. Aim of the studyThis study aims to present a technique for Canthopexy and Medial canthal ligament reconstitution secondary to posttraumatic medial canthal degloving injuries using mini-screws and/or microplates to obtain a consistent and definitive reinforcement of the Medial Canthal ligament and its continuity to the postero-superior surface of the medial orbital wall. Materials and methodsThe present study enrolled 23 patients with posttraumatic medial telecanthus deformity that had been treated over a 3-year period from July 2016–June 2019. Clinical examination had been scheduled for all patients regarding evaluation of lacrimal system function, medial canthal position in addition to eyelid measurements. Visual impairment and movements of the eye were evaluated by ophthalmological consultation. Irrigation and probing were used for evaluation of the nasolacrimal system. MCT detachment can be determined by Bowstringing test through subcutaneous palpation of the MCT as one stretches the lid laterally.Eyelid evaluation comprised recording measurements of the inter-canthal distance (ICD), the interpupillary distance (IPD) and the palpebral fissure length (PFL). Telecanthus was assessed by recording the distance (in millimetres) measured between the facial midline and the medial canthus of the injured eye that will be compared to the corresponding values of the uninjured eye preoperatively and at all postoperative follow-up intervals. Radiographic assessment was evaluated by axial, coronal and sagittal C.T scans preoperatively and at 1, 3 and 6 months postoperatively. ResultsMedial Canthopexy with mini-screws was performed in 15 patients while a Y-shaped micro plate was utilized in 8 patients. The postoperative medial canthal position had been reported to be satisfactory in all patients, showing a considerable improvement compared with the preoperative position. The patients were re-evaluated at 1,3 and 6 months postoperatively demonstrating absence of any evidence of recurrence and with an acceptable cosmetic result, as the medial canthal concavity had been successfully achieved. All patients were satisfied except one that was overcorrected and re-operated for re correction. Another one was under corrected and had undergone revision. However, at 6 weeks postoperatively, one patient had a wound dehiscence resulting in medial canthal detachment and required retreatment. In all patients (except for the one of wound dehiscence), the post-canthopexy Bow String test failed to cause loss of canthal re-attachment and reconstruction or even lateral displacement of the medial canthal tendon throughout all the follow-up intervals. ConclusionsMedial Canthopexy using mini-screws and/or microplates is a simple, easy and reliable technique for the surgical correction of posttraumatic Telecanthus secondary to MCT detachment as this technique promotes satisfactory post-surgical outcomes with resultant acceptable esthetic and functional results.

Modified Z-Epicanthoplasty Based on the Movement and Tension of Medial Canthal Area in Asian Females.

Z-epicanthoplasty is a popular method of correcting mild to moderate epicanthal folds. However, it has some limitations, such as, under correction, recurrence, and leaving of a visible scar. This study aimed to modify the traditional Z-epicanthoplasty to optimize its application in correcting severe cases of epicanthal fold. A total of 117 Asian female patients received the modified Z-epicanthoplasty between January 2018 and April 2018. The type and severity of epicanthal fold were evaluated preoperatively, whereas the intercanthal distance, interpupillary distance, and scar visibility and cosmetic results were evaluated preoperatively and one-year postsurgery. A total of 142 eyes had epicanthus tarsalis, whereas 92 eyes had epicanthus palpebralis. Of these, 29 were mild, 95 were moderate, and 119 were severe. After the operation, the intercanthal distance ratio was decreased from 0.615 (range, 0.548-0.685) preoperatively to 0.564 (range, 0.500-0.632). The mean reduction was 5.1% (range, 1.2%-10.1%; P < 0.001, Wilcoxon signed-rank test). Also, 195 eyes (83.3%) had no apparent scar and 36 (15.4%) had visible scar only under close inspection. Three eyes (1.32%) had visible scar without the need for revision. No reoccurrence was observed. And the cosmetic outcomes were scored as either excellent or good. The modified Z-epicanthoplasty which released the medial canthus activity sufficiently and corrected epicanthal fold at its maximum displacement is an effective method for the treatment of all degrees of epicanthus tarsalis and epicanthus palpebralis in Asian females.

Anthropometric Assessment of Canthal Distances and Canthal Index of South Indian Region: A Cross-Sectional Study

Background: Orbitofacial anthropometric measurements can be used in identification of gender and ethnicityin forensic anthropology. It also plays a crucial role used in plastic surgery and for identifying geneticsyndromes. Canthus is the term employed to explain the either corner of the eyes. Inner canthus is alsocalled as medial or nasal canthus. Outer canthus, is otherwise called as lateral or temporal canthus. Normalcanthal values can function as a guide for the diagnosis of pathology and interventions for craniofacialabnormalities. Thus, it is necessary to have a knowledge about the local data of those parameters sincethis standard reflects the doubtless different pattern of craniofacial growth resulting from racial, ethnic,sexual and dietary differences. Hence this study is undertaken to find out the normative inner canthal andoutercanthal distance measurement in population of South Indian region.Aims and Objectives: The present study was done to find out the normal inner and outercanthal distanceand also canthal index of population of South Indian ethnic origin and also to analyse the sexual dimorphismin them.Materials and Method: This descriptive cross-sectional study was conducted on 200 volunteers of agegroup 18-25 years of both sexes belonging to South Indian region. Innercanthal distance(ICD) and Outercanthal distance(OCD) were measured using digital vernier caliper.Canthal index was calculated. All thedata were analysed using SPSS 16.0 version software and correlated with gender.Results: Mean innercanthal distance was found to be 2.64 ±0.51 cm in males and 2.51 ±0.46 cm in femalesrespectively in the present study. There is significant sexual dimorphism in ICD . The study also showedoutercanthal distance to be 10.35± 0.81cm in males and 10.19 ±1.02 cm in females respectively. Canthalindex was 25.71 ±4.91 in males and 24.83±7.83 in females. There is no significant sexual dimorphism inOCD and Canthal index.Conclusion: It was observed that all the values were significantly higher in males than females of southIndian ethnic origin. And there is a significant sexual dimorphism in inner intercanthal distance.