M IBRAHIM KHAN

1. All about traumatic telecanthus.
Is perfection possible?
M. Ibrahim Khan
FRCSI, FCPS (Plastic Surgery)
Department of Plastic Surgery
Pakistan Institute of Medical Sciences
Islamabad

2. Anatomy

3. Anatomy

4. Nasoethmoidal-orbital
fractures- Types I & II

5. Types III & IV

6. Clinical exam
 Telecanthus
 Swelling
 Nasal deformity
 Instability- bimanual exam
 Other fractures
 CSF leak
 Lacrimal drainage

7. Radiographic exam
 Fractures isolating central fragment:
1. Frontal process-frontal bone junction
2. Medial orbital fractures
3. Inferior orbital rim fractures
4. Nasal fractures

8. Treatment
 No role for closed treatment
 Canthal ligament attached to bone?

9. Problems
 Getting it there
 Keeping it there

10. Exposure
 Bicoronal
 Lower eyelid
 Gingival buccal
sulcus
 Laceration
 Nasal incision

11. Other important steps
 Adequate dissection & release
 Scar excision
 Reduction
 Trans-nasal wiring
 Fixation of fractures
 Ancillary procedures
 Canthal reattachment
 Soft tissue reapproximation

12. Trans-nasal wiring

13. Canthal reattachment

14. Fracture fixation

15. Summary
 Early detection & intervention
 Good exposure
 Adequate release
 Correct vector of pull
 Soft tissue approximation to bone
 Correction of nasal deformity
 Has to look right on the table

16. Conclusion
 Pleasing outcome is a realistic aim

17. Thank you!