Medial Canthal Ligament Reattachment in Skull Base Surgery and Trauma

The medial and lateral canthal ligaments represent fibrous condensations of tissue anchoring the tarsal plates to the medial and lateral orbital rims. The medial canthal ligament extends anteriorly to the anterior lacrimal crest, posteriorly to the posterior lacrimal crest, and superiorly along the frontal process of the maxilla and the frontal bone. The medial canthal ligament’s multiplanar and multidirectional attachments give rise to the delicate three-dimensional contour of the medial canthus and serve as integral components of the lacrimal pump. Ideal restoration of the aesthetic form of the medial canthal region would recreate the three-dimensional attachment of the medial canthal ligament. A number of techniques have been described for canthal ligament attachment including the use of transnasal wires, microplates, and simple suture fixation. All available techniques resuspend the canthal ligament along the net vector of pull superoposteriorly. Proper vector estimation and subsequent pull execution may be technically difficult to achieve. Bone anchor systems have provided for effective longterm biomechanical stability in extremity tendon reattachment to bone as applied in the field of orthopedic surgery. Osseous screw fixation appears to be well suited to any of a number of clinical situations in which it is desirable to anchor soft tissue to bone, such as bladder suspension to the pelvis or periosteal attachment to the frontal bone in endoscopic brow lifting. The author has previously reported the utility of the bone anchor system to assist with canthal reattachment during external approaches for optic nerve decompression. This report outlines a simple, effective, and expeditious technique for medial canthal reattachment in skull base surgery and trauma using a prethreaded bone anchor system.