After central facial trauma, a patient has telecanthus and the medial canthus moves with gentle traction. CT shows a comminuted central fragment. Which operative objective is most important?
The tendon-bearing segment determines canthal position. Fixation that restores only bony contour but not tendon support can leave disabling telecanthus.
A. Reconstruct stable medial-canthal-tendon support while restoring central midface projection: The tendon-bearing segment determines canthal position. Fixation that restores only bony contour but not tendon support can leave disabling telecanthus.
B. Treat with nasal packing alone: Packing cannot restore skeletal or tendon stability.
C. Repair only the orbital floor: This does not address the medial canthal complex.
D. Delay all assessment until swelling resolves: Early specialist planning is needed in unstable central midface injury.
E. Perform isolated cosmetic rhinoplasty: This is inadequate for a structural NOE injury.
If the tendon remained attached to a large stable fragment, reduction and fixation planning would be less complex.
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