Medial canthopexy using transcaruncular barb and miniplate: technique and cadaver study

Traditional medial canthopexy techniques require transnasal access, periorbital skin incision, and/or direct canthal suturing, often yielding unpredictable outcomes. The transcaruncular canthal barb and miniplate technique is a simplified method of canthopexy that avoids these manoeuvres. 10 transcaruncular medial canthopexies were performed on cadavers with simulated naso-orbito-ethmoid (NOE) injury. Differences in mean pre-injury and post-canthopexy intercanthal distance (ICD) and palpebral aperture width (PAW) measurements were compared using a matched paired t test. Reliability between pre-injury and post-injury intercanthal distance and PAW was compared with intraclass correlation coefficients. Canalicular distortion and final implant position were assessed with post-canthopexy computed tomography (CT). There was no difference in mean palpebral aperture width (32.32 and 32.43 mm) or mean intercanthal distance (29.18 and 29.06 mm) between pre-injury and post-canthopexy groups (both p>0.05). All intercanthal distance and PAW intraclass correlation coefficients were >0.97 (p<0.05). Post-canthopexy, CT scans showed canaliculus distortion in 4/10 of upper and 0/10 of lower canaliculi with all canthal barbs in the correct position relative to the plate. In a cadaver telecanthus model, medial canthopexy using the transcaruncular barb and miniplate technique reliably reduces the medial canthus and did not distort the lower lacrimal canaliculus, but may distort the upper canaliculus.