A Standardized Surgical Technique for Tessier Medial Transnasal Canthopexy

Medial canthopexy is a surgical technique that allows correction of the position of the medial canthus, corresponding to the medial angle of the palpebral fissure. Abnormal position of the medial canthus is observed in the case of telecanthus (excessive intercanthal distance) or medial canthal dystopia (displaced medial canthus), encountered in congenital craniofacial malformations or after craniofacial trauma or tumoral resection that affects the orbits. Correcting the position of the medial canthus is a challenge for the training surgeon, due to the difficulty of the techniques. Medial transnasal canthopexy aims to reposition and fix the medial canthal tendon contralaterally with wires. This technique is difficult to realize, due to the need for successive transnasal passages of several wires with limited surgical access, and the small size and fragility of the medial canthal tendon. A learning curve is thus required. To date, literature is scarce concerning the description of the technique for medial transnasal canthopexy, and several variations of the technique are described. We aimed to describe a standardized, reproducible technique for bilateral medial transnasal canthopexy by an orbitonasal approach, based on Paul Tessier's technique, which our team has been experienced with for several years.