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Orbitomalar Suspension With Combined Single Drill Hole Canthoplasty

Purpose: Whether resulting from a surgical complication or involutional change, lower eyelid retraction and canthal dystopia can lead to lagophthalmos and frank ectropion. The authors present their experience with a single drill hole fixation for both the lateral canthus and suborbicularis oculi fat for severe canthal dystopia and lower eyelid retraction. Methods: In this retrospective, consecutive study, the medical records of 13 patients who underwent single drill hole canthoplasty and suborbicularis oculi fat suspension were reviewed. A 4-0 nonabsorbable polypropylene suture was used to secure the canthal tendon, passed through a single lateral orbital rim drill hole from inside out. The suborbicularis oculi fat was then suspended in the same manner. Outcome measurements included linear marginal reflex distance 2, lagophthalmos, and subjective assessment of the results by the patient. Results: Preoperatively, the average linear marginal reflex distance 2 was 7.3 ± 1.0 mm, the average lagophthalmos was 3.5 ± 0.8 mm, and the average horizontal palpebral fissure width was 25.7 ± 1.3 mm. Postoperatively, average linear marginal reflex distance 2 was 5.3 ± 0.7 mm (p < 0.05), average lagophthalmos was 0.3 ± 0.4 mm (p < 0.05), and average horizontal palpebral fissure width was 30.2 ± 0.7 mm (p < 0.05). All patients noted symptomatic relief and were satisfied with the appearance of their eyelids at 6 months of follow up. Conclusions: Single drill hole canthoplasty with suborbicularis oculi fat suspension is a viable alternative to previously described procedures. By using a single bony drill hole, rigid fixation is achieved with avoidance of multiple fixation points.