title: External dacryocystorhinostomy and transnasal canthopexy: new details of combined surgery.
abstract: OBJECTIVE
  To describe the authors' modified combined surgical technique for external dacryocystorhinostomy and transnasal canthopexy.
  
  
  METHODS
  A retrospective medical record review was performed including patients with late posttraumatic telecanthus and nasolacrimal duct obstruction treated by their combined dacryocystorhinostomy-transnasal canthopexy technique. In this technique, the bony window is extended superiorly and posteriorly further than in standard dacryocystorhinostomy, to allow pulling the canthus though the window, but at the same time not disturbing the suture of the dacryocystorhinostomy anastomosis. The lacrimal sac opening is performed under the canthal tendon, and only an anterior anastomosis is performed. Silicone intubation was performed only in cases with evidence of canalicular disease, marked sac inflammation or atrophic sac. The wires are fixed to the contralateral orbit, passed through the 2 middle holes of a 4-hole straight 1,7 mm microplate. The microplate is placed on the contralateral side to avoid in-fracture of the contralateral orbital bones from the pressure exerted by the transnasal wires.
  
  
  RESULTS
  Combined external dacryocystorhinostomy-transnasal canthopexy surgery was performed on 13 eyelids of 11 consecutive patients for correction of medial telecanthus and nasolacrimal duct obstruction. Proper canthal position and lacrimal pathway patency were achieved in all cases after a mean follow up of 14.6 months.
  
  
  CONCLUSIONS
  Combined dacryocystorhinostomy-transnasal canthopexy surgery with superior and posterior enlargement of the bony window avoided crossing of the wires and flaps and achieved a high success rate in the reconstruction of the lacrimal drainage pathway. This technique proved to be effective in the treatment of posttraumatic telecanthus with nasolacrimal duct obstruction.
authors.affiliation: *Ophthalmology Department, Oculoplastic Surgery Unit, Ramón y Cajal Universitary Hospital; †Ophthalmology Department. Oculoplastic Surgery Unit, La Princesa Universitary Hospital; ‡Oculoplastic Surgery Unit, Clinica Rementeria; and §Maxilofacial Surgery, Clinica Colmenero, Madrid, Spain.
authors.forename: Marco
authors.initials: M
authors.lastname: Sales-Sanz
authors.forename: Hae-Ryung
authors.initials: HR
authors.lastname: Won-Kim
authors.forename: Andrea
authors.initials: A
authors.lastname: Sales-Sanz
authors.forename: Cesar M
authors.initials: CM
authors.lastname: Colmenero
authors.forename: Andrea
authors.initials: A
authors.lastname: Sanz-López
mesh_terms: D000328:Adult; D019465:Craniofacial Abnormalities / Q000209:etiology / Q000601:surgery*; D003608:Dacryocystorhinostomy / Q000379:methods*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D007440:Intubation / Q000379:methods; D007767:Lacrimal Duct Obstruction / Q000209:etiology; D008297:Male; D008875:Middle Aged; D059747:Nasal Surgical Procedures / Q000379:methods*; D009301:Nasolacrimal Duct / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult