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Abstract. Lateral candial fixation is widely used. This article sought to determine if a periosteal flap used routinely in conjunction with a tarsaJ strip provides lasting lateral canthal fixation. This consecutive clinical series from two ambulatory surgery centers followed 79 patients who underwent 141 lateral canthal fixation procedures. Outcome was measured by the position of the lateral canthus. Correct positioning of the lateral canthus was achieved in 78 of 79 patients representing 139 of 141 procedures (98%). The failed case was a patient with floppy eyelid syndrome in whom the sutures tore through the tarsal strips. The tarsal strip-periosteal flap technique is a successful, technically direct method of lateral canthal fixation. It is promoted as an enhancement of the tarsal strip technique, and is especially helpful in patients with prominent eyes. [Ophthalmic Surg Lasers 1999;30:232-236.]
INTRODUCTION
In 1979, Anderson and Gordon described the tarsal strip procedure for lateral canthal fixation, wherein a freshened lateral tarsal end is prepared.1 Ten years later, the enhanced tarsal strip was developed by Jordan and Anderson.2 This technique differs in that it does not separate the tarsus anteriorly from the skin and muscle. Both procedures involved suturing the tarsal strip to the periosteum just inside the lateral orbital wall at WhitnalFs tubercle. The goal of this sometimes difficult maneuver is to recreate a firm adhesion between the eyelid and the lateral orbital wall. Various modifications of the lateral canthal fixation procedure have been suggested, but the object remains the same with a focal attachment of the tarsus to the periosteum.3'5 However, limitations accompany suture fixation within the lateral orbital wall. The bite of periosteum within the suture loop lacks control as it cannot be directly visualized. Technical difficulties may be encountered when passing and retrieving a needle just inside the lateral orbital wall in close proximity to the eye.
Periosteal flaps derived from the lateral orbital rim have been used for a variety of purposes in lateral canthal reconstruction. These include fullthickness defects of lateral aspects of the upper and lower eyelids,6'7 as well as creation of a new lateral canthal ligament if the excess horizontal eyelid is inadvertently removed.8 Recently, Charonis and Gossman9 have utilized a lateral periosteal flap in association with a niyectomy in the repair...