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Management of the Medial Canthal Tendon in Nasoethmoid Orbital Fractures: The Importance of the Central Fragment in Classification and Treatment
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
The authors gave a detailed description of the fracture classification of the central fragment. This classification is helpful in scientific reports and in clinical treatment, as it is well described and reproducible by others. The treatments described by the authors can be defined as an expert opinion. They are clear about the plate fixation of the Type I injuries and the indication for transnasal wiring in Type II and III injuries. It is not clearly described what the indications for additional bone grafting of the nasal dorsum and septum were. The authors stated that successful outcome of NOE fractures is dependent on reduction and stabilisation of the central fragment of the fracture with its medial canthal tendon. Although this statement has been supported by many others in the decades after this report, the authors do not clearly describe their parameters for failure or success in their original article. Unfavourable outcome, including telecanthus, was mentioned in general in the discussion section, but the outcome of their own research population was not clear.
Clefts and craniofacial
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Tessier introduced the term orbital hypertelorism (true lateralisation of the whole orbit, i.e. medial and lateral wall, which is usually due to failure of medialisation). See Table 4.3. Telecanthus is the increased intercanthal distance (where the orbit may be normal). It is a physical finding and not a disease/syndrome by itself.
Management of acute nasal trauma
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
Class 3: A high-energy injury to the nose, which leads to a complex fracture which extends into the ethmoid bone. The bony septum at the perpendicular plate of the ethmoid rotates backwards, taking the septum with it into the face. The nasal tip is also rotated upwards, giving greater show of the nostrils. There will be a saddle type deformity, and the nose will have a ‘pig-like’ appearance. Due to the disruption of the medial canthal ligament attachments, there may be telecanthus. This may be further complicated by dural tears, CSF leak and pneumocranium.
Dog bite injuries of the eye and ocular adnexa
Published in Orbit, 2019
Benjamin P. Erickson, Paula W. Feng, Sophie D. Liao, Yasha S. Modi, Audrey C. Ko, Wendy W. Lee
Though rare, medial degloving injuries may also result from dog bites.54 Symptoms of medial degloving injuries classically include telecanthus, epiphora, and ptosis.54,55 Causes of injury characteristically involve shearing or avulsion of the medial canthus, often due to a vertical incision from the eyebrow or forehead to the lower eyelid or cheek, causing medial canthal injury.54,55 Management consists of computed tomography to exclude fractures or retained foreign bodies.54,56 Ptosis, if present, may resolve spontaneously and can be managed with observation for 3–6 months. When necessary, ptosis repair should occur sooner in children, who are at risk of developing amblyopia due to ptosis.57,58 Reconstruction preferably occurs in a staged approach, with telecanthus and lacrimal reconstruction occurring first, followed by ptosis repair.54,55,59–62 Canine tooth syndrome
The Cry of the Third Eye: Exceptionally Rare Location of a Post-Traumatic Acquired Lacrimal Fistula
Published in Ocular Immunology and Inflammation, 2023
Richa Dharap, Nandini Bothra, Mohammad Javed Ali
A gentleman of 29-years presented to the lacrimal clinic with a history of epiphora in the right eye of four months duration. Epiphora was associated with discharge from the eye and the new opening on the forehead. The symptoms began following a facial trauma sustained in a motor vehicle accident. He was diagnosed with an NOE fracture and had undergone an open repair and internal fixation. Clinical examination demonstrated a depressed nasal bridge, madarosis of the right eyebrow, right telecanthus, and an acquired epicanthal fold (Figure 1a). There was an inflamed and discharging fistula with peri-fistulous scarring at the nasal bridge, just below the glabellar region (Figure 1a,b). There was purulent regurgitation from the ectopic fistula upon applying pressure over the right lacrimal sac area (Figure 1b). The lacrimal irrigation on the right side showed regurgitation from the opposite punctum and the fistula (Figure 1c). The left lacrimal drainage system was patent. The rest of the ocular examination in both eyes was unremarkable. Computer tomography- dacryocystography (CT-DCG) scans revealed superior migration of a large dilated right lacrimal sac with a partly sequestered fundus traversing through the frontal process of the maxilla and frontal bone, in close relation to the skull base and communicating with the fistula (Figures 1d,e). There were no plates or screws in the lacrimal sac region or the nasolacrimal duct (NLD). A diagnosis of traumatic secondary acquired lacrimal drainage obstruction (SALDO) with an ectopic lacrimal fistula was made. The surgical plan was a combined external and endoscopic fistulectomy with a dacryocystorhinostomy.
Ophthalmologic findings in the Cornelia de Lange syndrome
Published in Ophthalmic Genetics, 2019
The largest study in which the intercanthal distance was measured in patients indicated that telecanthus (60%) is more commonly found than hypertelorism (30%) (11). A study of 34 patients with HDAC8 mutations and CdLS-like features described hypertelorism in 47% and telecanthus in 64% (6). Nicholson et al. reviewed 48 cases and also noted telecanthus, but not hypertelorism (23). In a report of 12 cases of CdLS that were based on clinical diagnosis, 16.6% demonstrated hypertelorism (24) although no description of methodology was reported. The methodology of measurement does greatly influence the interpretation of the oculofacial findings (13).