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Coronal approach


Lateral canthopexy
If the lateral canthal attachments to Whitnall’s tubercle have been detached, re-anchoring to the bone is advisable.
The lateral canthus should be reattached inside the orbit and not to the rim. A secure reattachment of the canthal tendon to the bone can be achieved by drilling a hole through the lateral orbital rim.
The lateral canthus in Caucasians is usually slightly higher than the medial canthus. 
The vertical and sagittal positioning of the drill hole inside the orbital wall is determined by identification of Whitnall’s tubercle.
The drill hole can be enlarged in an upward or downward direction for final adjustments.
A double armed suture is passed through the lateral canthal tendon and passed through the hole in the lateral orbital wall. It is then passed through the temporalis fascia and secured.