surgerymax
Iron
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Normal canthoplasty
The lateral canthal tendon is actually detached. A lateral canthotomy is made at the outer corner, inferior cantholysis releases the lower crus, and now you have complete mobility of the lower lid. The canthus can be repositioned and then reconstructed at a new location with real tension , thus you can not only raise the lateral canthus but the tension from this will lift tighten the lower eyelid.The gold standard within canthoplasty is the tarsal strip technique.
The problems that come with it
Every fixation technique faces the same engineering challenge being that you need to hold the canthus against forces that are constantly trying to pull it back down. The question is what you're anchoring your suture to.In standard canthopexy and most canthoplasty techniques, you're anchoring to periosteum
This has structural limitations that become apparent over months and years meaning a degree relapse of the canthoplasty is very common.
Bone Drill Fixation (Bone drill cantho)
Standard canthopexy and canthoplasty both ultimately rely on sutures anchored to periosteum. Periosteum is soft tissue. It can stretch, it can be cut through by suture tension over time thus relapse can happen , with bone drill fixation you are attaching the lateral canthus structures the bone via the wire passing through the drill holes , meaning a much more powerful anchor.
The bone drill fixation bypasses these issues , not only that but you can get a more aggressive change with the actual procedure so not only much lower chances of relapse but also a better actual result. (Not healed yet ofc)
In this paper the authors describe what would be considered a reliable and standard technique for lateral canthoplasty, a double hole lateral orbital rim canthal repositioning technique done through an upper eyelid incision , there did not seem to be any significantly complications and though alot of hypercorrection may be needed to make the permanent result as the patient desired , all patients were satisfied with their results
https://www.researchgate.net/public...c_Canthopexy_Drill_Hole_Canthal_Repositioning
Of course it is based on client request , you don't have to go anywhere near as upturned as some of these retarded patients chose to do so.
Combination of Lower Eyelid Retraction Repair (LERR)
LERR in itself helps massively to prevent relapse in canthoplasty as it removes opposing forces that are acting against the fixationThe lower lid retractors , the capsulopalpebral fascia and its associated smooth muscle fibers originate from the inferior rectus muscle, wrap around the inferior oblique, and insert onto the inferior edge of the tarsal plate.
Their job is to pull the lower lid down when you look down
When these retractors become tight, scarred, or contracted, they exert constant downward tension on the lid margin even at rest.
This probably sounds like a bunch of jargon basically what you need to understand is that the lower eyelid will create forces acting against the canthoplasty and is a big contributor to relapse
A LERR will remove this force as the retractors are surgically released their insertion on the tarsal plate therefore eliminating the tension on the lid.
After LERR the lid is no longer being actively pulled downward
Even with bone drill fixation you can place the most stable lateral anchor possible, but if the retractors are still tight and pulling the lid downward across its full length, you've only fixed the lateral corner. The central portion of the lid will still sit too low because the bone drill anchors the outer corner
What this will result in is the canthus itself sitting at an ideal height the lateral angle is sharp and defined but the central lid margin is still showing sclera.
When combined
LERR removes the pulling force
Bone drill canthopexy provides the stable lateral anchor
So you can get a result that not only looks better but is MUCH less likely to relapse
Periosteal canthopexy (regular cantho) plus LERR sometimes still relapses because even with the retractors released, the soft tissue anchor of the canthopexy stretches over time. The lid then drifts despite the LERR working as intended. Bone drill canthopexy removes this weak link entirely
Important to note though I am extrapolating alot of information of mechanistic reasoning when entering the realm of bone drill canthoplasty as it is quite new , the ideas presented i believe would be broadly quite accepted amongst surgeons and do all make sense logically.
Thanks for reading.
