A 46-year-old woman presented after sustaining a mechanical fall into a bed post. A systemic examination revealed a neurologically intact and medically stable patient. Attention was then directed to her facial injuries. Clinical assessment revealed a large avulsed laceration extending from the glabellar area down to the bridge of the nose, a 50% avulsed laceration of the lower eyelid originating from the medial canthal area and a distal upper eyelid canthal laceration with injury to the canalicular system. A traction test confirmed a disrupted medial canthal tendon. Palpation over the bones demonstrated no bony crepitus or clicks. Ophthalmic examination showed 20/20 vision OU, no pupillary deficits, and a normal fundo-scopic examination. A facial computed tomography (CT) scan was negative for any nasoethmoidal fractures (Fig. 9.3).
Surgical intervention was carried out under general anesthesia. Exploration of the lacerations confirmed the preoperative assessment. Repair of both upper and lower eyelid lacerations was performed after bicanalicular silicone intubation and repair of the upper canalicular laceration. The medial canthal avulsion was re-approximated using deep sutures and bolsters and completing medial canthopexy. Finally, the glabellar laceration was repaired (Fig. 9.4).
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