Where should the medial canthal tendon be reattached in a case of unilateral naso-orbital-ethmoid injury?

The medial canthal tendon plays a crucial role in the support of the eyelids and the proper positioning of the canthus. In cases of unilateral naso-orbital-ethmoid (NOE) injuries, it is essential to reattach the medial canthal tendon to a stable structure that can provide adequate support and restore function.

Reattaching the tendon to the contralateral nasal bone or the medial orbital rim is ideal because these sites are stable structures that can help maintain the position of the medial canthus. The contralateral nasal bone or medial orbital rim is anatomically positioned to provide proper tension and alignment for the tendon, which ensures the correct orientation of the eyelids and contributes to aesthetic and functional outcomes after the injury.

In comparison, reattaching the tendon to the ipsilateral lacrimal bone may not provide adequate stability, as it is frequently involved in the injury, potentially compromising the reattachment site. The anterior nasal spine does not serve as a suitable anchor point for the tendon, as it is not directly related to the eyelid's functional dynamics. The lower eyelid margin is also inappropriate for reattachment, as it does not provide the structural integrity necessary for proper function and cosmetic appearance.

Therefore, choosing the contral