Significance of the lateral canthal tendon in craniofacial surgery

Craniofacial approaches to the anterior skull base involve manipulation or removal of the supraorbital and frontozygomatic orbital margins. Necessarily, structures within the orbit are detached from the orbital margins. The lateral canthal tendon is attached to the inner aspect of the frontozygomatic process on the orbital osseous tubercle and is essential to the structural fixation of the lateral canthus as well as a check on the mobility of the lateral canthal angle of the eye itself. Our anatomic studies on the lateral canthal tendon as well as specific neurosurgical considerations in its mobilization are reviewed. The detachment of the lateral canthal tendon may result in blunting of the lateral canthal angle, a distraction of the eyelid away from the globe, or an asymmetric repositioning of the canthus as compared with the contralateral angle. It would appear that if the periosteum of the orbit is carefully dissected from the orbital rim and reapproximated following the procedure, the lateral canthal tendon insertion and function will not be disturbed unless the bony orbit margins are altered. In these instances, further ocular plastic surgery may be required.