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CHAPTER 3: Upper Facial Trauma
Resident Manual of Trauma to the Face, Head, and Neck
70
pathology, many surgeons prefer to apply a corneal protector for the
security and safety of this tissue during fracture repair.
4. Lower Lid Abnormalities
Failure to adequately reconstitute the proper intercanthal distance
through reduction and fixation of the bone to which the medial canthal
tendons are attached can lead to lower eyelid laxity and ectropion.
Depending on the severity of the ectropion, an additional lower lid
shortening procedure may be required, with or without a medial canthal
tendon tightening. Malposition of the medial canthus can also be a
complication of poor repositioning of NOE fractures (Figure 3.29).
Adequate time for healing and tissue firming should be allowed before
recommending these procedures.
Figure 3.29
Malpositioned right
medial canthus, with
persistent right
traumatic telecanthus
and chronic epiphora
due to eversion of the
inferior punctum.
5. Persistent Telecanthus
One particularly common and troublesome complication is the inad-
equate reduction and fixation of the NOE fractures, leading to a persis-
tently widened intercanthal distance and an unpleasant appearance to
this area of the face. In a few patients, this could actually be a “pseudo-
telecanthus,” where persistent soft tissue edema and scarring have
given the appearance of a telecanthus.
A trial of gentle massage over time as well as consideration for steroid
injections into the soft tissue (away from the canthal tendons) may be
successful. If the telecanthus is due to inadequate narrowing of the
NOE complex, then consideration can be given to the performance of
osteotomies, reduction, and refixation. Because this procedure is
difficult, the surgeon should have experience in its conduct.
6. Failure to Correct Medial Orbital Tissue Entrapment
Normally, exposing the medial orbital blowout fracture and releasing the
tissue from entrapment will be sufficient to prevent subsequent fat