Step 4 Lateral Canthotomy and Inferior Cantholysis

If a lateral canthotomy is used, the approach begins with it. One tip of pointed scissors is placed inside the palpebral fissure, extending laterally to the depth of the underlying lateral orbital rim (approximately 7 to 10 mm). The scissors are used to cut horizontally through the lateral palpebral fissure (Fig. 3-4). The structure cut in the horizontal plane are skin, orbicularis muscle, orbital septum, lateral canthal tendon, and conjunctiva.

Figure 3 4 Initial incision for lateral canthotomy.

The traction sutures are used to evert the lower lid. Note that the lower lid is still tethered to the lateral orbital rim by the inferior limb of the lateral canthal tendon (Fig. 3-5). This is isolated by retraction and incised with scissors. To perform the contholysis, the scissors will need to be positioned with a vertical orientation (Fig. 3-6). Once the cantholysis is complete, an immediate release of the lower lid from the lateral orbital rim is noted (Fig. 3-7). The surgeon will be able to evert the lower lid more effectivelly.

Figure 3 5 Anatomic dissection shoing result after initial canthopexy illustrated in Figure 3-3. Note that the inferior limb of the lateral canthal tendon (*) is still attached to the lower tarsus, preventing mobilization.
Canthotomy
Figure 3 7 Anatomic dissection shoing rsult after cantholysis illustrated in Figure 3-5. Note that the inferior limb of the lateral canthal tendon (*) has been severed, allowing the lower lid great mobility.

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