A Modified Bifurcated Periosteal Flap for Simultaneous Reconstruction of Upper and Lower Lateral Canthal Tendons

A bifurcated periosteal flap is useful for simultaneous reconstruction of the upper and lower lateral canthal tendons. The original technique harvested the flap horizontally from the frontal process of the zygoma, which mostly resulted in an insufficient flap length because of the narrowness of the zygoma. Here, the authors report the use of a modified bifurcated periosteal flap, raised from the superolateral orbital rim. The lower flap was positioned to slant inferiorly to create a downward slope of the lower eyelid for smooth lacrimal drainage by gravity. The authors applied this technique to 2 patients and obtained good cosmetic results without complications such as entropion, ectropion, lower-eyelid sagging, epiphora, or lateral canthal deformity.