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ABSTRACT
Locating the cut medial ends of canaliculi after trauma or surgery can be difficult. In cases of double canalicular or common canalicular lacerations, injection of sodium hyaluronate (Healon®) directly into the lacrimal sac may help pinpoint the medial openings.
Identification of the medial ends of surgically or traumatically induced double canalicular lacerations or common canalicular lacerations can be difficult. We describe the use of sodium hyaluronate (Healon®) injections directly into the lacrimal sac as an aid to identification of the medial openings in such cases.
CASE REPORT
A 41-year-old man in good general health had had a 6mm right medial canthal lesion for approximately a year. Three years earlier, he had undergone surgical excision of a basal cell carcinoma in the same region. A biopsy revealed recurrent basal cell carcinoma. Surgical lamellar resection was performed using theMohs' technique. The subsequent medial canthal defect measured approximately 0.9 cm by 2.0 cm (Figure 1).
On the following day, the patient was brought to the operating room for surgical reconstruction. Inspection of the defect through the operating microscope revealed preservation of approximately the lateral 3 mm of the upper canaliculus and 2 mm of the lower canaliculus. The medial canaliculi, medial portions of the upper and lower eyelids, and the anterior aspects of the medial canthal tendon had been resected. Direct inspection of the lacrimal sac region and attempted probings failed to pinpoint medial openings.
Therefore, the periosteum anterior to the anterior lacrimal crest was elevated and...