Surgical Technique
The “Leicester Lasso” Lateral Canthoplasty Ruben Y. Kannan, M.B., M.R.C.S.Ed., Ph.D., F.R.C.S(Plast)., Joo L. Chuah, M.B., M.R.C.Ophtal., F.R.C.S(Ophthal)., Joyce Burns, M.B., M.R.C.Ophtal., F.R.C.S(Opthal)., and Raghavan G. Sampath, M.B., M.S., M.R.C.Ophthal., F.R.C.S(Ophthal). Department of Oculoplastic Surgery, Leicester Royal Infirmary, Leicester, United Kingdom
Purpose: To describe an innovative technique of lateral canthal tendon (LCT) anchoring to the lateral orbital rim on its inner aspect using a “lasso” technique, in order to provide the ideal vector. Methods: A retrospective case review of seven patients (n = 7), performed from 2009 to 2013 at our institution by the senior author (RGS). Results: Excellent results in all cases with optimal restoration of form and function. Conclusions: The "Leicester Lasso" technique is a safer technique of securing the LCT to the orbital rim. (Ophthal Plast Reconstr Surg 2014;30:186)
grasped using these tiny loops and pulled through to allow the sutures to pass from within outward, before being sutured and anchored to the bone. This atraumatic technique minimizes trauma to the globe, is quick, and is user-friendly. Patients’ are usually kept in as day cases and in this case series of 7 cases, the postoperative recovery and period were uneventful. (Supplemental Digital Content 1, video, http://links.lww.com/IOP/A87).
RESULTS Of a total of 7 cases (n = 7) of “Leicester Lasso” canthoplasties performed at our institution, all patients’ herein exhibited optimal LCT vectoring with good aesthetics and function. There were no reported complications.
DISCUSSION
T
he lateral canthal tendon (LCT) anchors both the eyelids to the lateral aspect of the orbital rim, thereby forming the palpebral fissure laterally. It is positioned at approximately 2 mm superior to the medial canthal line and is posterior, relative to the medial canthal tendon. Instances in which the LCT requires fixation may be postsenescence, edema, post-trauma, or iatrogenic.1 Fixation methods previously described include periosteal hitching, Mitek bone anchors (Norwood, MA),2 and transosseous sutures. The latter is preferred by the team, but securing the LCT from the inside out can be difficult, given the proximity of the globe. In these situations, a “lasso” technique was used to ease the procedure as described herein.
SURGICAL TECHNIQUE Under a local anesthetic, a laterally extended curvilinear upper blepharoplasty incision is used to expose the lateral orbital rim after bluntly dissecting away the orbicularis oculi.3 The LCT is then dissected out at the lateral palpebral fissure region, and multiple suture passes with 4/0 Prolene are used to secure the LCT. In the next step, two 1.6-mm holes are drilled in the lateral orbital rim as required, which are sufficiently large for a lacrimal probe to pass through it. A 4/0 silk suture is then twisted over itself to form a tiny loop (lasso), which is then passed through the bony tunnels. The cut end of the Prolene suture is then
In cases where the vector of the LCT is required to be more posterior to achieve anatomical repositioning, anchoring the LCT to the lateral orbital rim from its inner surface to outward is the preferred method in practice. Previously, this study found that using transosseous sutures with a suture needle through the drill holes in close proximity to the globe is cumbersome and potentially dangerous to the globe. Given this, the senior author (R.G.S.) developed an innovative and convenient method of grasping the LCT sutures with a twisted silk loop, passed through the drilled osseous tunnels. This allows to complete the procedure within 15 to 20 minutes, and given its ease, the authors are not compelled to anchor the LCT to the outer lateral orbital rim as a backup option. Given the flexibility that this technique offers, the authors suggest the lasso technique to the fraternity as a useful technique when LCT transosseous anchoring to the inner aspect of the lateral orbital rim is desired.
REFERENCES 1. McCord CD, Boswell CB, Hester TR. Lateral canthal anchoring. Plast Reconstr Surg 2003;112:222–37; discussion 238–9. 2. Bartsich S, Swartz KA, Spinelli HM. Lateral canthoplasty with the Mitek anchor system. Aesthetic Plast Surg 2012;36:3–7. 3. Ortiz-Monasterio F, Rodriguez A. Lateral canthoplasty to change the eye slant. Plast Reconstr Surg 1985;75:1–10.
Accepted for publication June 18, 2013. The authors disclose no financial or conflicts of interest. Address correspondence and reprint requests to Ruben Y. Kannan, M.B., M.R.C.S.Ed., Ph.D., F.R.C.S(Plast)., Leicester Royal Infirmary, 5, Renishaw Drive, Leicester LE5 5TY, United Kingdom DOI: 10.1097/IOP.0b013e3182a22ab8
186
Ophthal Plast Reconstr Surg, Vol. 30, No. 2, 2014
The “Leicester Lasso” Lateral Canthoplasty Ruben Y. Kannan, M.B., M.R.C.S.Ed., Ph.D., F.R.C.S(Plast)., Joo L. Chuah, M.B., M.R.C.Ophtal., F.R.C.S(Ophthal)., Joyce Burns, M.B., M.R.C.Ophtal., F.R.C.S(Opthal)., and Raghavan G. Sampath, M.B., M.S., M.R.C.Ophthal., F.R.C.S(Ophthal). Department of Oculoplastic Surgery, Leicester Royal Infirmary, Leicester, United Kingdom
Purpose: To describe an innovative technique of lateral canthal tendon (LCT) anchoring to the lateral orbital rim on its inner aspect using a “lasso” technique, in order to provide the ideal vector. Methods: A retrospective case review of seven patients (n = 7), performed from 2009 to 2013 at our institution by the senior author (RGS). Results: Excellent results in all cases with optimal restoration of form and function. Conclusions: The "Leicester Lasso" technique is a safer technique of securing the LCT to the orbital rim. (Ophthal Plast Reconstr Surg 2014;30:186)
grasped using these tiny loops and pulled through to allow the sutures to pass from within outward, before being sutured and anchored to the bone. This atraumatic technique minimizes trauma to the globe, is quick, and is user-friendly. Patients’ are usually kept in as day cases and in this case series of 7 cases, the postoperative recovery and period were uneventful. (Supplemental Digital Content 1, video, http://links.lww.com/IOP/A87).
RESULTS Of a total of 7 cases (n = 7) of “Leicester Lasso” canthoplasties performed at our institution, all patients’ herein exhibited optimal LCT vectoring with good aesthetics and function. There were no reported complications.
DISCUSSION
T
he lateral canthal tendon (LCT) anchors both the eyelids to the lateral aspect of the orbital rim, thereby forming the palpebral fissure laterally. It is positioned at approximately 2 mm superior to the medial canthal line and is posterior, relative to the medial canthal tendon. Instances in which the LCT requires fixation may be postsenescence, edema, post-trauma, or iatrogenic.1 Fixation methods previously described include periosteal hitching, Mitek bone anchors (Norwood, MA),2 and transosseous sutures. The latter is preferred by the team, but securing the LCT from the inside out can be difficult, given the proximity of the globe. In these situations, a “lasso” technique was used to ease the procedure as described herein.
SURGICAL TECHNIQUE Under a local anesthetic, a laterally extended curvilinear upper blepharoplasty incision is used to expose the lateral orbital rim after bluntly dissecting away the orbicularis oculi.3 The LCT is then dissected out at the lateral palpebral fissure region, and multiple suture passes with 4/0 Prolene are used to secure the LCT. In the next step, two 1.6-mm holes are drilled in the lateral orbital rim as required, which are sufficiently large for a lacrimal probe to pass through it. A 4/0 silk suture is then twisted over itself to form a tiny loop (lasso), which is then passed through the bony tunnels. The cut end of the Prolene suture is then
In cases where the vector of the LCT is required to be more posterior to achieve anatomical repositioning, anchoring the LCT to the lateral orbital rim from its inner surface to outward is the preferred method in practice. Previously, this study found that using transosseous sutures with a suture needle through the drill holes in close proximity to the globe is cumbersome and potentially dangerous to the globe. Given this, the senior author (R.G.S.) developed an innovative and convenient method of grasping the LCT sutures with a twisted silk loop, passed through the drilled osseous tunnels. This allows to complete the procedure within 15 to 20 minutes, and given its ease, the authors are not compelled to anchor the LCT to the outer lateral orbital rim as a backup option. Given the flexibility that this technique offers, the authors suggest the lasso technique to the fraternity as a useful technique when LCT transosseous anchoring to the inner aspect of the lateral orbital rim is desired.
REFERENCES 1. McCord CD, Boswell CB, Hester TR. Lateral canthal anchoring. Plast Reconstr Surg 2003;112:222–37; discussion 238–9. 2. Bartsich S, Swartz KA, Spinelli HM. Lateral canthoplasty with the Mitek anchor system. Aesthetic Plast Surg 2012;36:3–7. 3. Ortiz-Monasterio F, Rodriguez A. Lateral canthoplasty to change the eye slant. Plast Reconstr Surg 1985;75:1–10.
Accepted for publication June 18, 2013. The authors disclose no financial or conflicts of interest. Address correspondence and reprint requests to Ruben Y. Kannan, M.B., M.R.C.S.Ed., Ph.D., F.R.C.S(Plast)., Leicester Royal Infirmary, 5, Renishaw Drive, Leicester LE5 5TY, United Kingdom DOI: 10.1097/IOP.0b013e3182a22ab8
186
Ophthal Plast Reconstr Surg, Vol. 30, No. 2, 2014
