Name: A Standardized Surgical Technique for Tessier Medial Transnasal Canthopexy (Video) | JoVE Journal
Uploaded: 2026-01-23T13:15:00.000+00:00
Duration: 6 min 8 s
Description: Learn a standardized Tessier medial transnasal canthopexy technique using an orbitonasal approach for precise medial canthal tendon fixation. This video protocol enhances surgical education and improves patient outcomes.

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5 minutes

We thank Ecole de chirurgie Tourangelle (Tours University Hospital, Tours, France) and Pr Christophe Destrieux, Neurosurgery department, Ecole de chirurgie Tourangelle (Tours University Hospital, Tours, France), for making this study possible.

The protocol follows the guidelines of the H&#244;pitaux Clocheville et Trousseau human research ethics committee. Informed consent was obtained from all participants for this study.
1. Pre-operative evaluation
<ol>
	<li>Perform pre-operative evaluation of intercanthal distance with measurements of intercanthal distance with a caliper.</li>
	<li>Perform a CT scan pre-operatively to evaluate orbital bone structures and ensure sufficient stability for the passage of the steel wires and fixation of the medial canthal tendon.</li>
</ol>
2. Installation
<ol>
	<li>Under general anesthesia, position the patient supine, with centered oro-tracheal intubation.</li>
	<li>Disinfect the patient according to the local protocol, and drape the patient using a sterile technique.</li>
	<li>Disinfect the nasal fossa and endonasal wicking with naphazoline (storage and use at ambient temperature).</li>
	<li>In addition to the standard precautions followed classically (hand disinfection, adapted sterile gloves), ensure eyewear protection, and follow particular precautions when using the steel wires to avoid cutaneous injury. Wearing two pairs of gloves is recommended.</li>
</ol>
3. Drawing of the incision lines
<ol>
	<li>Draw the incision line on each side according to Tessier orbitonasal incision, following a bayonet-shaped line at the medial canthus, which continues with a sub-tarsal approach (Figure 1). Create a succession of broken lines to facilitate dissection and limit the risk of residual visible retractile scars.</li>
	<li>In case of unilateral medial transnasal canthopexy, draw the incision line according to the Tessier orbitonasal approach at the affected side, and at the contralateral side, draw an arcuate incision line measuring approximately 1.5 cm, anterior to the medial canthal tendon (MCT) (Supplementary Figure 1).</li>
</ol>
4. Realization of the orbitonasal approach
<ol>
	<li>Infiltrate the incision sites and the medial canthus region with subperiosteal infiltration with 1% adrenaline-lidocaine (storage at 2 &#176;C and 8 &#176;C, use at ambient temperature) in the absence of contraindication.</li>
	<li>Perform a skin incision with an 11-scalpel blade until reaching the plane of the orbicularis muscle, extending laterally to the lateral canthus, according to the defined incision lines</li>
	<li>Continue dissection with Ragnell scissors in the preseptal plane down to the periosteum, at the site of the infraorbital margin.</li>
	<li>Perform incision of the periosteum with a 15-scalpel blade along the infraorbital margin.</li>
	<li>Dissect the infraorbital margin in a subperiosteal plane with an elevator and roughen the orbital floor and medial wall for approximately 2 cm to obtain good exposure.</li>
	<li>After exposure, probe the lower lacrimal passage with a lacrimal probe to facilitate dissection.</li>
	<li>Gradually dissect medially the orbicularis muscle with Ragnell scissors until the MCT is exposed.</li>
	<li>Isolate the MCT along its entire length and detach it from the periosteal plane with Ragnell scissors and an elevator.</li>
	<li>Dissect the medial wall in a subperiosteal plane with an elevator, pushing the lacrimal sac downward, as well as the superior orbital rim and the inner part of the orbital roof. Take care not to fracture the very thin lamina papyracea during dissection.</li>
	<li>Release the lacrimal passages and lacrimal sac up to the lacrimonasal canal with the use of an elevator.</li>
	<li>Expose the ascending process of the maxilla with an elevator.</li>
</ol>
5. Performing the contralateral orbitonasal approach
<ol>
	<li>Perform the contralateral orbitonasal approach according to the same procedure described previously (section 4).</li>
	<li>In case of unilateral medial canthopexy, perform an orbitonasal approach at the affected side, the side where the medial canthus needs to be reinserted, and perform contralaterally, an arcuate incision line measuring approximately 1.5 cm with the use of a 15-scalpel blade, anterior to the MCT, measuring approximately 10 mm (Supplementary Figure 1).</li>
</ol>
6. Creating the transosseous wire
<ol>
	<li>Perform the bony path: perforate the maxillary frontal process with the largest square pin (3 mm diameter) behind the anterior lacrimal crest or at the level of the posterior lacrimal crest, in a slightly backward direction in order to apply traction of the medial canthus in the direction of the orbital apex. Protect the eye and lacrimal sac with a malleable retractor during this step.</li>
	<li>Then, use the fine square pin (1 mm diameter) to perforate the nasal septum with a posterior and deeper trajectory than the first perforation (step 6.1).</li>
	<li>On the contralateral side, make the perforation at the level of the lacrimal crest, just above the superior border of the medial canthal tendon. Be sure to protect the eyeball and lacrimal sac during this step.</li>
</ol>
7. Creating a transnasal wire &#34;shuttle&#34; using non-locking 1 # steel wire for passing the metal threads through the bony defects
<ol>
	<li>First, form a loop by folding the wire in half, ensuring it passes through the bone starting from one side towards the contralateral side.</li>
	<li>Insert two additional loops head-to-head (Figure 2) using the first loop inserted at step 6.1; these loops will allow the passage of steel wires that will be inserted on the MCT (section 8), on each side. 
	NOTE: Care must be taken to avoid tangling the wires when passing them through the nasal pyramid.</li>
	<li>For unilateral medial canthopexy, perform step 7.1, insert the loop from the affected side to the contralateral side, and then only insert one additional loop, using the first loop inserted in step 7.1, as a guide.</li>
</ol>
8. Insertion of staged wires on the medial canthal tendon, and contralateral transnasal passage with the wire &#34;shuttle&#34;
<ol>
	<li>Pass three different 3/0 locking steel wires through the medial canthal tendon carefully, ensuring a secure grip.</li>
	<li>Cut each of the three wires with different lengths to avoid confusion and secure them with &#39;mosquito&#39; clamps.</li>
	<li>Pass the wires through the metal loop on the affected side in pairs and fold them onto themselves (Figure 3).</li>
	<li>Gradually pull the loop, allowing the transnasal passage of the wires.</li>
	<li>Once the loop is passed, remove it and place the different steel wires in pairs. 
	NOTE: Care must be taken to avoid the patient&#39;s eye injury when passing the steel wires.</li>
</ol>
9. Contralateral fixation of the medial canthus tendon by blocking the steel wires on a metallic cleat
<ol>
	<li>Create a metallic cleat by twisting and tightening three or four number 1 steel wires, each about 1 cm long, together.</li>
	<li>Anchor the steel wires on the cleat, placed against the maxillary process. It is important to achieve an overcorrection.</li>
	<li>Perform insertion of staged wires on the contralateral medial canthal tendon, contralateral transnasal passage with the wire &#34;shuttle&#34;, and fixation of the medial canthus tendon by blocking the steel wires on a metallic cleat, as described previously (sections 8 and 9).</li>
</ol>
10. Skin closure
<ol>
	<li>For orbitonasal approach closure, close in two layers: reapproximate the maxillary periosteum to the periorbital tissue using Polyglactin 4/0 sutures, and perform skin closure with Polypropylene 6/0 sutures.</li>
	<li>For the contralateral side in case of unilateral canthopexy, close in one layer the skin with interrupted Polypropylene 6/0 sutures. 
	NOTE: The procedure is now complete. Refer to standard institutional procedures to manage surgical and chemical waste (used steel wires, used sutures, etc).</li>
</ol>
11. Post-operative care
<ol>
	<li>Administer artificial tears, application of ophthalmic ointment such as Sterdex (Oxytetracycline, Dexamethasone) twice daily, and use cold eye compresses (compresses soaked in cold physiological serum) for 48 h to reduce edema.</li>
	<li>Monitor vision, including light perception, multiple times daily. 
	NOTE: Frequency of ophthalmological check should be decided by the surgeon, in accordance with clinical aspects, post-operative evolution, and institutional practices.</li>
</ol>

<ol><li>Dutton, J. J. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aDutton%2C+JJ+%22Atlas+of+clinical+and+surgical+orbital+anatomy%22">Atlas of clinical and surgical orbital anatomy</a>. , 3rd ed, Springer. Cham. (2023).</li>
<li>Rougier, J., Tessier, P., Hervouet, F., Woillez, M., Derome Lekieffre, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Orbito-palpebral+plastic+surgery%5BTitle%5D)+AND+%22Bull+Mem+Soc+Fr+Ophtalmol%22%5BJournal%5D)">Orbito-palpebral plastic surgery.</a> Bull Mem Soc Fr Ophtalmol. 89, 125-130 (1977).</li>
<li>Abdelmegeed, A. G., Haredy, M. M., Mazeed, A. S., Hifny, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Transnasal+medial+canthopexy+supported+with+autogenous+bone+graft%3A+A+new+method+for+repair+of+traumatic+telecanthus%5BTitle%5D)+AND+%22J+Craniofac+Surg%22%5BJournal%5D)">Transnasal medial canthopexy supported with autogenous bone graft: A new method for repair of traumatic telecanthus.</a> J Craniofac Surg. 33 (7), e6736(2022).</li>
<li>Chu, Y. Y., Lim, E., Liao, H. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Ipsilateral+transnasal+medial+canthopexy+to+correct+secondary+telecanthus+after+naso-orbito-ethmoid+fracture%5BTitle%5D)+AND+%22J+Plast+Reconstr+Aesthet+Surg%22%5BJournal%5D)">Ipsilateral transnasal medial canthopexy to correct secondary telecanthus after naso-orbito-ethmoid fracture.</a> J Plast Reconstr Aesthet Surg. 73 (5), 934-941 (2020).</li>
<li>Laure, B., Petraud, A., Sury, F., Goga, D., Krastinova, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Transnasal+canthopexy%5BTitle%5D)+AND+%22Rev+Stomatol+Chir+Maxillofac%22%5BJournal%5D)">Transnasal canthopexy.</a> Rev Stomatol Chir Maxillofac. 111 (1), 36-42 (2010).</li>
<li>Bouhadana, G., Gornitsky, J., Saleh, E., Oliveira Trabelsi, N., Borsuk, D. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Expanding+the+classic+facial+canons%3A+Quantifying+intercanthal+distance+in+a+diverse+patient+population%5BTitle%5D)+AND+%22Plast+Reconstr+Surg+Glob+Open%22%5BJournal%5D)">Expanding the classic facial canons: Quantifying intercanthal distance in a diverse patient population.</a> Plast Reconstr Surg Glob Open. 10 (4), e4268(2022).</li>
<li>Méhes, K., Kitzvéger, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Inner+canthal+and+intermamillary+indices+in+the+newborn+infant%5BTitle%5D)+AND+%22J+Pediatr%22%5BJournal%5D)">Inner canthal and intermamillary indices in the newborn infant.</a> J Pediatr. 85 (1), 90-92 (1974).</li>
<li>Pool, G. M., Didier, R. A., Bardo, D., Selden, N. R., Kuang, A. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Computed+tomography-generated+anthropometric+measurements+of+orbital+relationships+in+normal+infants+and+children%5BTitle%5D)+AND+%22J+Neurosurg+Pediatr%22%5BJournal%5D)">Computed tomography-generated anthropometric measurements of orbital relationships in normal infants and children.</a> J Neurosurg Pediatr. 18 (2), 201-206 (2016).</li>
<li>Kim, T. G., Chung, K. J., Kim, Y. H., Lim, J. H., Lee, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Medial+canthopexy+using+Y-V+epicanthoplasty+incision+in+the+correction+of+telecanthus%5BTitle%5D)+AND+%22Ann+Plast+Surg%22%5BJournal%5D)">Medial canthopexy using Y-V epicanthoplasty incision in the correction of telecanthus.</a> Ann Plast Surg. 72 (2), 164-168 (2014).</li>
<li>Turgut, G., Ozkaya, O., Soydan, A. T., Baş, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+new+technique+for+medial+canthal+tendon+fixation%5BTitle%5D)+AND+%22J+Craniofac+Surg%22%5BJournal%5D)">A new technique for medial canthal tendon fixation.</a> J Craniofac Surg. 19 (4), 1154-1158 (2008).</li>
<li>Okazaki, M., Akizuki, T., Ohmori, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Medial+canthoplasty+with+the+Mitek+anchor+system%5BTitle%5D)+AND+%22Ann+Plast+Surg%22%5BJournal%5D)">Medial canthoplasty with the Mitek anchor system.</a> Ann Plast Surg. 38 (2), 124-128 (1997).</li>
<li>Sales-Sanz, M., Won-Kim, H. R., Sales-Sanz, A., Colmenero, C. M., Sanz-López, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((External+dacryocystorhinostomy+and+transnasal+canthopexy%3A+New+details+of+combined+surgery%5BTitle%5D)+AND+%22Ophthalmic+Plast+Reconstr+Surg%22%5BJournal%5D)">External dacryocystorhinostomy and transnasal canthopexy: New details of combined surgery.</a> Ophthalmic Plast Reconstr Surg. 30 (3), 257-261 (2014).</li>
<li>Goldenberg, D. C., Bastos, E. O., Alonso, N., Friedhofer, H., Ferreira, M. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+role+of+micro-anchor+devices+in+medial+canthopexy%5BTitle%5D)+AND+%22Ann+Plast+Surg%22%5BJournal%5D)">The role of micro-anchor devices in medial canthopexy.</a> Ann Plast Surg. 61 (1), 47-51 (2008).</li>
</ol>

The authors have nothing to disclose.

This technique does have certain limitations. In particular, it can be challenging to precisely determine the degree of overcorrection required to achieve an optimal outcome. The amount of tension applied to the steel sutures is not always easy to control, and tension-related asymmetry or relapse may occur. Using this technique, we experienced no minor or major complications. However, undercorrection of the medial canthal tendon, or relapse, may occur. Noticeably, transnasal canthopexy seems to achieve more stable result...

An abnormal position of the medial canthus is observed in the case of telecanthus, which is defined by an excessive intercanthal distance or medial canthal dystopia, corresponding to a displaced medial canthus. Telecanthus can be uni- or bilateral, resulting in rounding of the palpebral fissure as well as flattening of the caruncle. This may lead to functional consequences such as epiphora or pseudoptosis (false sensation of eyelid drooping), as well as aesthetic consequences. Telecanthus and/or canthal medial dystopia are encountered in various congenital craniofacial malformations (such as craniosynostosis syndromes, orodigitofacial dysostosis, Waardenburg syndrome, etc) or after craniofacial trauma or tumoral resection that affects the orbits. In these cases, medial canthal tendon repositioning is required to correct morphological and functional consequences. Medial canthopexy is a surgical technique that allows correction of the position of the medial canthal tendon, corresponding to the medial angle of the palpebral fissure, in a stable and permanent manner. 
Anatomically, the medial canthal ligament contains two bundles: an anterior bundle, which is stronger and thicker, inserting anterior to the anterior lacrimal crest, and a posterior bundle, which is thinner and more fragile, inserting on the posterior lacrimal crest. The lacrimal sac is located in the lacrimal groove, posterior to the medial canthal tendon1.
Transnasal canthopexy was first described by Francoise Firmin in 1972 and then codified by Paul Tessier2. To date, literature is scarce concerning the description of the technique for medial transnasal canthopexy, and several variations of the technique are described3,4. 
We aimed to describe a standardized, reproducible technique for bilateral medial transnasal canthopexy by an orbitonasal approach, based on Paul Tessier's technique, which our team has been experienced with for several years.5
Indeed, the execution of this technique is not always straightforward, especially in the case of bilateral medial canthopexy. This difficulty is explained by the need for successive transnasal passages of several wires with limited surgical access, as well as the small size and fragility of the medial canthal tendon. These factors make the execution of this technique challenging; it is thus important to carefully follow each step to achieve a good result. 
Due to the difficulty of the technique, there is a need for a detailed protocol that will illustrate step by step the different stages of the procedure to facilitate learning and execution.

<table><tbody><tr><td>Adson Dissection Forceps without Hook L 120 mm</td><td>BBRAUN AESCULAP</td><td>BD220R</td><td></td></tr><tr><td>Beyer Double Articulating Gouge Curved L 160 mm D 2 mm</td><td>MICROFRANCE INTEGRA</td><td>CP380-2</td><td></td></tr><tr><td>Bipolar Cable Dual Input Ref 40493IP or HF0100034 or HF0100033</td><td>INTEGRAL PROCESS</td><td>4043IP</td><td></td></tr><tr><td>Bipolar Forceps L 160 mm</td><td>INTEGRAL PROCESS</td><td>080416A</td><td></td></tr><tr><td>Bistoury Handle No. 3 L 130 mm</td><td>BBRAUN AESCULAP</td><td>BB073R</td><td></td></tr><tr><td>Debakey Dissection Forceps L 150 mm Jaws 2 mm</td><td>BBRAUN AESCULAP</td><td>FB400R</td><td></td></tr><tr><td>Desmarres Retraction Forceps L 140 mm L 14 mm - 18 mm</td><td>BBRAUN AESCULAP</td><td>OA312R</td><td></td></tr><tr><td>Eyelid Retractor (One Pair)</td><td>BBRAUN AESCULAP</td><td>BT177R</td><td></td></tr><tr><td>Farabeuf Retractor (One Pair) L 110&amp;ndash;150 mm</td><td>LANDANGER</td><td>B80130</td><td></td></tr><tr><td>Farabeuf Retractor (One Pair) L 120 mm H 20&amp;ndash;25 mm L 7&amp;ndash;9 mm</td><td>LANDANGER</td><td>B80120</td><td></td></tr><tr><td>Frazier Suction Cannula D 3 mm</td><td>LANDANGER</td><td>196010203</td><td></td></tr><tr><td>Gillies Dissection Forceps with Hook L 155 mm</td><td>BBRAUN AESCULAP</td><td>BD660R</td><td></td></tr><tr><td>Gillies Hook (One Pair)</td><td>LANDANGER</td><td>B80350</td><td></td></tr><tr><td>Halstead Hemostatic Forceps L 120&amp;ndash;140 mm with Curved Hook</td><td>LANDANGER</td><td>B50420</td><td></td></tr><tr><td>Halstead Hemostatic Forceps without Curved Hook L 120&amp;ndash;125 mm</td><td>LANDANGER</td><td>BH111R</td><td></td></tr><tr><td>Hasley Needle Holder L 130 mm with Tungsten BM012R</td><td>BBRAUN AESCULAP</td><td>BM012R</td><td></td></tr><tr><td>Iridectomy Scissors Curved L 105&amp;ndash;120 mm</td><td>LANDANGER</td><td>B89005</td><td></td></tr><tr><td>Iridectomy Scissors Straight L 105 mm</td><td>MEDLANE</td><td>3403</td><td></td></tr><tr><td>Kerrison Bone Punch L 180 mm Jaws 90&amp;deg; 2 mm</td><td>BBRAUN AESCULAP</td><td>FK949R</td><td></td></tr><tr><td>Kocher Hemostatic Forceps with Hooks Straight L 160 mm</td><td>LANDANGER</td><td>B50210</td><td></td></tr><tr><td>Malleable Blade L 210 mm L 10 mm - 12 mm - 15 mm - 17 mm - 20 mm</td><td>MICROFRANCE INTEGRA</td><td>CP818-10</td><td></td></tr><tr><td>Mayo Curved Scissors L 150 mm without Tungsten</td><td>LANDANGER</td><td>B25485</td><td></td></tr><tr><td>Micro Adson Dissection Forceps with Hook L 120 mm</td><td>BBRAUN AESCULAP</td><td>BD510R</td><td></td></tr><tr><td>Obwegeser Osteotome L 230 mm Curved Width 11 mm</td><td>BBRAUN AESCULAP</td><td>DO720R</td><td></td></tr><tr><td>Obwegeser Osteotome L 230 mm Curved Width 8 mm</td><td>STYKER</td><td>01-17852</td><td></td></tr><tr><td>Obwegeser Rasp A B C D L 180 mm</td><td>MICROFRANCE INTEGRA</td><td>CP344A B C D</td><td></td></tr><tr><td>Obwegeser Rasp Sharp AT BT L 180 mm</td><td>MICROFRANCE INTEGRA</td><td>CP344AT CP344BT</td><td></td></tr><tr><td>Ragnell Curved Scissors L 150 mm</td><td>MICROFRANCE INTEGRA</td><td>CP616-15</td><td></td></tr><tr><td>Ruler L 200 mm</td><td>KLS MARTIN</td><td>17-412-20-07</td><td></td></tr><tr><td>Ryder Needle Holder L 135 mm Jaws 2 mm with Tungsten</td><td>BBRAUN AESCULAP</td><td>BM054R</td><td></td></tr><tr><td>Square Pin&amp;nbsp;</td><td>KLS MARTIN</td><td>48.316.21.07</td><td></td></tr><tr><td>Tessier Scissors L 140 mm Straight Sharp without Tungsten</td><td>LANDANGER</td><td>B89030</td><td></td></tr></tbody></table>

a standardized surgical technique for tessier medial transnasal canthopexy

A Standardized Surgical Technique for Tessier Medial Transnasal Canthopexy

Medial canthopexy is a surgical technique that allows correction of the position of the medial canthus, corresponding to the medial angle of the palpebral fissure. Abnormal position of the medial canthus is observed in the case of telecanthus (excessive intercanthal distance) or medial canthal dystopia (displaced medial canthus), encountered in congenital craniofacial malformations or after craniofacial trauma or tumoral resection that affects the orbits. 
Correcting the position of the medial canthus is a challenge for the training surgeon, due to the difficulty of the techniques. Medial transnasal canthopexy aims to reposition and fix the medial canthal tendon contralaterally with wires. This technique is difficult to realize, due to the need for successive transnasal passages of several wires with limited surgical access, and the small size and fragility of the medial canthal tendon. A learning curve is thus required. 
To date, literature is scarce concerning the description of the technique for medial transnasal canthopexy, and several variations of the technique are described. We aimed to describe a standardized, reproducible technique for bilateral medial transnasal canthopexy by an orbitonasal approach, based on Paul Tessier's technique, which our team has been experienced with for several years.

This technique is reliable and long-lasting. It is a technique that can be difficult to master, with a steep learning curve, and requires a methodical approach and careful adherence to the successive surgical steps to achieve satisfactory results. Concerning bilateral canthopexy, it is important to be particularly cautious, especially with the different steel sutures passed transnasally, to avoid mixing them up. It is crucial to perform the canthopexy using three different steel sutures to fix the lateral canthal ligamen...

Medial canthopexy allows correction of the position and fixation of the medial canthal tendon. Due to the technical difficulties of this procedure, there is a need for a detailed protocol for educational purposes. Here, we describe a standardized reproducible technique for bilateral medial transnasal canthopexy by an orbitonasal approach.

Medial canthopexy is a surgical technique that allows correction of the position of the medial canthus, corresponding to the medial angle of the palpebral ...

Tessier medial canthopexy is a technically-challenging surgical procedure that benefits greatly from video-assisted instruction for educational purposes. To begin, draw the incision line on each side of the face by following the Tessier orbitonasal incision along a bayonet-shaped line at the medial canthus, extending into a subtarsal approach. Create a sequence of broken lines along the incision to assist in dissection and reduce the risk of visible retractile scarring.Infiltrate the incision sites and the medial canthus area with a subperiosteal injection of 1%adrenaline lidocaine solution, provided there are no contraindications. Using an 11 scalpel blade, perform a skin incision along the previously-marked lines, cutting down to the orbicularis muscle plane and extending laterally toward the lateral canthus. Then, using Ragnell scissors continued dissection through the preseptal plane until reaching the periosteum at the infraorbital margin.Using a 15 scalpel blade incise the periosteum along the infraorbital margin. With an elevator, dissect the infraorbital margin in a subperiosteal plane. Then, roughen approximately two centimeters of the orbital floor and medial wall to achieve sufficient exposure.Now, insert a lacrimal probe into the lower lacrimal passage to assist in identifying anatomical structures during dissection. Isolate the medial canthal tendon along its entire length. Using an elevator, dissect the medial orbital wall in a subperiosteal plane, pushing the lacrimal sac downward, and then continue dissection.Expose the ascending process of the maxilla, using an elevator. To create the transosseous wire, using the largest square pin, make a bony perforation in between the anterior and posterior lacrimal crest. Angle the perforation slightly backward to direct the medial canthus traction within a posterior orientation.Use a malleable retractor to shield the eye and lacrimal sac during the procedure. On the contralateral side, perform a bone perforation at the level of the lacrimal crest, just above the upper edge of the medial canthal tendon. Use a malleable retractor to protect the eyeball and the lacrimal sac during this step.To begin creating a transnasal wire shuttle, fold the wire in half to form a loop. Pass this loop through the bone defect, from one side to the opposite side. Insert two additional wire loops head to head, using the first loop.Gradually pull the loop from the opposite side to draw the steel wires transnasally through the bone tunnels. Once the loop has successfully pulled the wires through, remove the loop and arrange the wires separately. Carefully pass three separate 3/0 locking steel wires through the medial canthal tendon, ensuring each wire has a firm and secure hold.Pass the wires in pairs through the metal loop, located on the affected side, and fold them back onto themselves to prepare for transnasal passage. Gradually pull the wire shuttle with the three attached steel wires at the opposite side in the transnasal passage. Then, remove the loop and place the wire distinctly for bilateral fixation later.Create a metallic cleat by twisting together three or four number 1 steel wires, each approximately one centimeter in length, and tighten them securely. Anchor the passed steel wires onto the metallic cleat, positioning it firmly against the maxillary process. Then, cut the steel wires.To close the orbitonasal approach, close the skin layer, using interrupted 6/0 polypropylene sutures. In patients with craniosynostosis, transnasal medial canthopexy achieved visibly-improved facial symmetry and orbital alignment post-operatively with corresponding changes confirmed by craniofacial CT scans. Over the past 10 years, nine unilateral and five bilateral transnasal medial canthopexies were performed in patients aged nine to 79 years with congenital dystopia or traumatic orbital bone injuries, achieving satisfactory results.Two patients required dacryocystorhinostomy due to persistent epiphora following the procedure. There is a lack of educational and vital support concerning transnasal canthopexy. Our publication will help train surgeon for the realization of this technique.Our protocol allows precise anatomical fixation of the medial canthal ligament with stable results, ensuring a satisfactory outcome.

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Optic Nerve transection is a widely used model of adult CNS injury. Ninety percent of retinal ganglion cells (RGCs) whose axons are completely transected (axotomy) die within 14 days after axotomy. This model is easily amenable to experimental manipulations and highly reproducible.

Optic Nerve Transection: A Model of Adult Neuron Apoptosis in the Central Nervous System

Capsulorhexis is an important step in phacoemulsification surgery. A surgeon creates a continous curvilinear tear on the anterior lens capsule by controlling the tearing vector forces. A peripherally extended tear is a serious complication. This video demonstrates a novel technique of rescuing capsular radial tear out using a cystotome.

A Novel Technique of Rescuing Capsulorhexis Radial Tear-out using a Cystotome

Minimally invasive thumb-sized pterional craniotomy for aneurysm clipping has afforded our patients with a shorter hospital stay at a lower cost compared to the national average.

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms

The aim of this paper is to describe the different steps of the endoscopic endonasal approach to the sella turcica.

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

The goal of this protocol is to present transcanalicular laser-assisted dacryocystorhinostomy as a minimally invasive approach in the treatment of primary acquired nasolacrimal duct obstruction.

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

The present protocol describes a modified and simplified technique with a minimally invasive transverse aortic constriction (TAC) procedure using a self-made retractor. This procedure can be conducted without a ventilator or microscope and introduces pressure overload, eventually leading to cardiac hypertrophy or heart failure.

A Modified Technique for Transverse Aortic Constriction in Mice

This protocol describes Trabeculotome Tunneling Trabeculoplasty (3T)—a minimally invasive glaucoma surgery that includes trabecular incision, Schlemm’s canal (SC) dilation, and tension suture implantation to restore physiological aqueous outflow—accompanied by a noncomparative case series.

Trabeculotome Tunneling Trabeculoplasty (3T): A Step-by-Step Surgical Protocol for Primary Open-angle Glaucoma

Short visual description of the surgical technique and device used for the delivery of (gene and cell) therapies into the spinal cord.  The technique is demonstrated in the animal but is entirely translatable and currently being used for human application.

Surgical Technique for Spinal Cord Delivery of Therapies: Demonstration of Procedure in Gottingen Minipigs

We describe the protocols used to investigate the interactions of 13.56 MHz radiofrequency (RF) electric-fields with gold nanoparticle colloids in both non-biological and biological systems (in vitro/vivo). These interactions are being investigated for applications in cancer therapy.

Protocols for Assessing Radiofrequency Interactions with Gold Nanoparticles and Biological Systems for Non-invasive Hyperthermia Cancer Therapy

The tibial nerve transection model is a well-tolerated, validated, and reproducible model of skeletal muscle atrophy. The model surgical protocol is described and demonstrated in C57Black6 mice.

Tibial Nerve Transection - A Standardized Model for Denervation-induced Skeletal Muscle Atrophy in Mice

Learn a standardized Tessier medial transnasal canthopexy technique using an orbitonasal approach for precise medial canthal tendon fixation. This video protocol enhances surgical education and improves patient outcomes.

A Standardized Surgical Technique for Tessier Medial Transnasal Canthopexy

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