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A.C. Tutela, P. Langer; Simultaneous Repair Of Medial Canthal Tendon Avulsion And Inferior Canalicular Laceration: A New Technique . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3773.
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To describe a new technique to repair medial canthal tendon avulsions associated with inferior canalicular lacerations.
Retrospective chart review of patients who suffered lower eyelid lacerations that involved the lower canaliculus and that also avulsed the posterior crus of the medial canthal tendon; all patients underwent the simultaneous repair of the avulsed tendon and the canalicular laceration by this technique. The presence or absence of epiphora and the appearance of the medial canthus were assessed three months postoperatively.
Between July 1999 and October 2005, 32 patients suffered a simultaneous medial canthal tendon avulsion and lower canalicular laceration. The traumatic defect was repaired with the following steps: (1) The cut ends of the canaliculus were intubated with a monocanalicular stent; (2) A horizontal mattress 4–0 vicryl suture was placed posterior to the medial and lateral cut ends of the canaliculus. This suture, which reapproximated the posterior crus of the medial canthal tendon, was passed medially near the posterior lacrimal crest, the natural insertion of the posterior crus of the canthal tendon. The suture was left untied; (3) A horizontal mattress 7–0 vicryl suture was then placed anterior to the cut ends of the canaliculus, just tangent to the mucosa of the canaliculus, and was also left untied. This suture will reapproximate the torn canaliculus; (4) While the assistant pulled the avulsed eyelid medially and gently fed the excess stent into the medial cut end of the canaliculus, the 4–0 vicryl suture was securely tied; (5) The 7–0 vicryl suture was then tied to reapproximate the canaliculus; (6) The eyelid and skin lacerations were then addressed in the usual fashion. Of the 32 patients in the study, none had epiphora three months post–operatively. Additionally, each repaired medial canthus possessed a natural concavity symmetric with the opposite side.
The normal insertion of the posterior crus of the medial canthal tendon at the posterior lacrimal crest allows the eyelid to follow the curvature of the globe medially, and results in the natural concavity of the medial canthal area. Failure to address an avulsion of the posterior crus will result in an anterior insertion point of the tendon and a loss of the natural concavity of this area postoperatively. Our technique addresses the proper reapproximation of the posterior crus, while also allowing for the effective repair of the lower canaliculus. Preplacing the sutures and stent prior to closing allows for the structures to be reapproximated with their normal anterior to posterior anatomic relationships preserved.
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