Kahn's wire passer used in medial canthal tendon fixation

Management of Panfacial Fracture

Traumatic panfacial fracture repair is one of the most complex and challenging reconstructive procedures to perform. Several principles permeate throughout literature regarding the repair of panfacial injuries in a stepwise fashion. The primary goal of management in most of these approaches is to restore the occlusal relationship at the beginning of sequential repair so that other structures can fall into alignment. Through proper positioning of the occlusion and the mandibular-maxillary unit with the skull base, the spatial relationships and stability of midface buttresses and pillars can then be re-established. Here, the authors outline the sequencing of panfacial fracture repair for the restoration of anatomical relationships and the optimization of functional and structural outcomes.

Medial canthopexy: a proven technique

The medial canthus comprises three limbs and functions to maintain the shape of the eye and to assist in drainage of the lacrimal sac. Repair of the medial canthal tendon is often complicated by canthal drift, extrusion of wires or sutures, and in-fracture of the contralateral orbital bones from pressure by transnasal wires. A technique used successfully for more than 25 years with a low rate of complications is described in a stepwise manner. The long-term outcomes of using this technique are reviewed. Thirty-three patient charts were reviewed. The mean age of patients was 22.4 years (range, 3 to 59 years). The surgical indications were trauma, neoplasm, and congenital deformity. Only 2 cases of canthal drift were noted after this procedure and were corrected with the same technique without recurrence. Traditional methods of medial canthopexy frequently result in complications; the technique described eliminates most if not all of these.