La canthopexie transnasale

Medial canthopexy is a permanent and stable fixation of the internal canthus and its elements in an anatomical position. Transnasal canthopexy is difficult to perform. The specific material includes two square pins, a large and a small one, plus material to explore the lachrymal duct. After infiltration with adrenalin xylocaine at 1 %, the Tessier's orbitonasal incision follows a bayonet route along the medial canthus and then a sub-tarsal route. A succession of broken lines allows increasing the maxillary upward branch and a larger sub-periosteal dissection. The medial canthal tendon (MCT) is exposed. After intubating the inferior lachrymal duct and pushing the lachrymal sac downwards, any resistance to medial traction is freed with a raspatory. The contralateral approach is arch formed, in front of the MCT, 10 mm away from the medial eyelid commissure. The frontal apophysis of the maxillary bone is exposed. The bone is perforated with a square pin while protecting the lachrymal sac and the ocular globe. The MCT is pulled by twisted metallic wire, which is anchored on a wedge. Closing the wound is performed in two layers. A large dressing is applied for 48 hours. In case of medial bone defect, parietal bone graft is used to stabilize canthopexy. There are few complications and esthetic and functional results are favorable and long lasting.