Various techniques have been described in the literature for eyelid reconstruction. This leaves the inner eyelid surface exposed and prone to irritation. A small defect encompasses less than onethird of the lower eyelid and can usually be repaired by primary closure. Reconstruction of fullthickness lower eyelid defects l. A technique for the reconstruction of lower eyelid. The incision is then continued laterally to the preauricular crease toward the level of the earlobe. Efficacy of thick acellular human dermis alloderm for lower eyelid reconstruction. The anterior lamella was reconstructed with orbicularis muscle advancement and a free skin graft from the ipsilateral upper eyelid. Eyelid apposition and lacrimal function were preserved. Original article efficacy of thick acellular human dermis.
The next order of reconstruction involves lid sharing. We use a system of vertical subunits to classify defects and guide reconstruction. Lower eyelid reconstruction following a traumatic full. Eyelid reconstruction an oculoplastic surgical coding. Composite auricular chondrocutaneous graft is useful for. Beard flap with ear cartilage to replace missing tarsal plate. Reconstruction of the upper eyelid is more challenging than that of the lower eyelid due to the highly specialized function of the upper eyelid. Small defects can be directly sutured closed, even if they extend through the full thickness of the eyelid. Reconstruction of the eyelids, correction of ptosis, and. Reconstruction of the lower eyelid by third eyelid lateral.
A patient with lower eyelid retraction who showed bilateral improvement in lower eyelid position after thick acellular human dermis thick alloderm lifecell corporation, the woodlands, tex graft placement. Eyelid reconstruction by renowned expert suzanne freitag and esteemed coeditors n. Apr 01, 2017 1 alo eye care, kolkata, india keywordseyelid reconstructionlid margin defectslateral canthotomyrotational flapswitch flaptarso conjunctival flapmyocutaneous flapcutlerbeard bridge flap 12. Six cases requiring total upper and lower eyelid reconstruction were identified and are summarized in table 1. Indications for full thickness skin grafts were excision of eyelid tumors 98% and cicatricial ectropion 2%.
When repairing lower eyelid defects, one must ensure proper eyelid closure while avoiding the complications of eyelid notching, entropion and ectropion. The book provides a quick and practical ophthalmic plastic surgery guide on how to plan and perform a full spectrum of. Bottom, upper lid exci sion and outline of semicircle graft. Posterior lamellatarsal plate, medial and lateral canthal tendons, capsulapalpebral fascia, lid retractors and conjunctiva. Understand an algorithm of upper eyelid reconstruction. Techniques and outcomes of total upper and lower eyelid. Lower eyelid reconstruction after basal cell carcinoma removal abstract we describe the clinical features in a case series of 64 patients presenting with a primary basal cell carcinoma bcc involving. After photos were taken 3 months after surgeryprocedure.
Lower eyelid reconstruction following a traumatic full thickness loss. You may have already had your skin cancer removed by another surgeon, but you feel that you no longer look your best as a result. Jan 11, 2019 ectropion ektrohpeeon is a condition in which your eyelid turns outward. It also provides information on what you can expect when you come to hospital. Lower eyelid reconstruction using pedicled skin flap and. In full thickness lower eyelid injuries, it will involve both anterior and posterior lamella. It is the most common eyelid malignancy and accounts for approximately 90% of eyelid tumors. Methods from 2009 to 20, upper eyelids with meibomian gland. Large forehead, brow, or cheek flaps are eliminated, as is the need for closure of the palpebral fissure during the early healing course. Modified hughes procedure for reconstruction of large full. Attention to reconstruction of the bilamellar eyelid structure is essential holds jb, facial plast surg clin n am 24. Defects in the eyelid can also arise from trauma or scarring from previous surgeries. Lower eyelid defects are common, and a systematic approach to reconstruction of the lower eyelid is required. If you have any further questions, please speak to a doctor or nurse caring for you.
Reconstruction of lower eyelid retraction or ectropion using a paranasal flap. Eyelid reconstruction may be necessary for a variety of reasons besides tumors and their excision. This article describes the reconstruction of the lower eyelid in two layers. Pr47 comprehensive eyelid reconstruction codner 2007. Anatomy eyelid is traditionally described as a bilaminar structure. Aug 17, 2016 visiting expert from the eye center of columbus, kenneth cahill, md, offers valuable tips on best practices for eyelid reconstruction. Eyelid tumour removal and reconstruction surgery this leaflet explains more about tumour removal and reconstruction surgery, including the benefits, risks and any alternatives.
Lower eyelid defect repair algorithms vary based on the size and location of the defect. This is why the vertical midface lift and hard palate graft reconstruction for lower eyelid were developed. It is caused by the attenuation of soft tissue over the maxilla. Eyelid reconstruction by the semicircle flap technique. Zplasty to eliminate tension on the flap advanced medially. Eyelid reconstruction riva lee asbell philadelphia, pa part. Picture 1 shows features of ageing eyelid picture 1 features of ageing eyelid lower eyelid beauty a young and beautiful attractive lower eyelid should be smooth and wrinklefree. The reconstruction is similar to the modified hughes procedure for reconstruction of large full defects of the lower eyelid, in which a single tarsoconjunctival flap is used and the eyelid. The aim of eyelid cancer reconstruction is to reconstruct the eyelid after ensuring the cancerous tissue has been excised. If prior eyelid surgery compromised both the upper and the lower eyelid, sometimes by repairing just the lower eyelid, the chronic corneal exposure is sufficiently improved that eye comfort and appearance is restored. It requires knowledge of various surgical techniques and anatomy to obtain satisfactory functional and aesthetic results eyelid defects can be divided into congenital and acquired and can be due to diverse etiologies, with cutaneous tumors being one of the most prevalent, especially the nonmelanoma. Large lower eyelid defects can be replaced with adjacent cheek semicircular cheek flap or hfigure plasty or upper lip tissue.
Lower eyelid reconstruction after basal cell carcinoma removal abstract we describe the clinical features in a case series of 64 patients presenting with a primary basal cell carcinoma bcc involving the lower lid andor adjacent inferior periocular. In severe ectropion, the entire length of the eyelid is turned out. Total upper lid reconstruction uses the lower lid cutler. Most animals with properly reconstructed eyelids have minimal complications. Trauma is the most common cause leading to reconstruction of the lower lid. The end goal of eyelid reconstruction is both functional and aesthetic restoration of the eyelid and periocular area while. In this case, a rotational advancement cheek flap and composite graft were used to reconstruct the lower eyelid. Lower eyelid reconstruction after basal cell carcinoma. Eyelid tumor excision and trauma are 2 common causes of eyelid defects requiring surgical reconstruction. Patient presented with bilateral cicatricial ectropion involving the right lower eyelid and the left lower eyelid. Eyelid cancer excision and reconstruction may be necessary if you have developed a skin cancer on your eyelids. Unfortunately, these skin cancers are relatively common if you have had a lot of exposure to the sun. In 2448 hours, the eyepad is removed and the patient can use the eye. Similar to the upper eyelid, lower eyelid defects are treated based on size and on which layer is missing.
Esthetic dentistry third edition, 2015 related terms. Clinical relevance blepharoplasty using a cutaneous transposition flap sutured to the scarified surface of a relocated third eyelid should be considered for reconstruction of lower eyelid defects with. Mucosa is provided by mobilizing the bulbar conjunctiva. Attention to the bilaminar eyelid anatomy and canthal support structures, with efforts.
Upper and lower eyelids have been formed for their specific functions by nature. Reconstruction of the lower eyelid by lateral advancement using a. Because there are many surgical methods to repair and reconstruct the eyelid, the surgeon must determine which technique is most appropriate to restore the natural eyelid contour for each. Reconstruction of the lower eyelid can be approached algorithmically. Therefore, auricular chondrocutaneous grafting was performed. Pdf the goals of eyelid reconstruction are to provide adequate globe coverage, proper closing mechanics, preservation of tear film integrity.
Eyelid reconstruction codes be aware that procedure codes 67961 excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement. Pdf reconstruction of the eyelids after mohs surgery. A wide subcutaneous undermining proceeds, the extent of which is determined by the laxity of the skin and the extent of the defect. For superficial defects involving up to 20% of lower lid length, primary closure is usually possible in older patients. Ochiai h 201 composite auricular chondrocutaneous graft is useful for lower eyelid reconstruction after surgery for cancer of the maxilla glob surg, 201 doi. Blepharoplasty eyelid lift is a procedure in which excess skin and fat from the upper and lower eyelids is removed. Modified hughes procedure is a safe and effective option for the reconstruction of small and large defects of the lower eyelid, regardless of the type of anterior lamella. Visiting expert from the eye center of columbus, kenneth cahill, md, offers valuable tips on best practices for eyelid reconstruction. Sep 21, 2018 trauma is the most common cause leading to reconstruction of the lower lid. The book provides a quick and practical ophthalmic plastic surgery guide on how to plan and perform a full spectrum of periocular reconstruction procedures.
There are several options available for upper eyelid reconstruction that depend on the extent of involvement of the anterior and posterior lamella. Reconstruction of one half to more than three fourths of the lower or upper eyelid can be accomplished without borrowing tissue from the eyelids, nose, ear, or mouth. Grace lee, daniel lefebvre, and michael yoon fills a void in the literature. Pdf reconstruction of eyelids defects researchgate. Tumour removal and reconstruction v4 guys and st thomas. Modified tripier flap in reconstruction of the lower eyelid. Aug 01, 20 the same steps are followed for the lower eyelid, except that the incision should be directed laterally in the skin tension line fig. Original article efficacy of thick acellular human. Purposeto explore the clinical effect of the pedicled lower lidsharing flap for fullthickness reconstruction of the upper eyelid. Pdf the goals of eyelid reconstruction are to provide adequate globe coverage. The tarsal plate is no longer taken into consideration. To undertake the reconstruction of the eyelids, it is very important to understand. Lower eyelid reconstruction jama otolaryngologyhead.
A technique for the reconstruction of lower eyelid marginal. Pdf modified tripier flap in reconstruction of the lower. Reconstruction of the lower eyelid is a challenge for plastic surgeons. The eyelid is a thin structure with the ability to open and close to lubricate and protect the ocular surface while allowing an unobscured visual axis to see. Eyelid reconstruction riva lee asbell philadelphia, pa. Nov 14, 2018 upper eyelid tissue can be replaced with lower eyelid tissue by the mustarde or cutlerbeard multistage procedures. Eyelid reconstructionoriginal pdf all ebook stores. Modified hughes procedure for reconstruction of large fullthickness.
Basal cell carcinoma bcc is the second most common cause of eyelid reconstruction. Full thickness lower to upper eyelid flap repair, e. Jun 26, 2016 reconstruction of the lower eyelid can be approached algorithmically. Have a basic understanding of techniques for upper eyelid reconstruction. Pdf reconstruction of lower eyelid retraction or ectropion. Eyelid reconstruction an overview sciencedirect topics. Principles and techniques of eyelid reconstruction springerlink. Europeans, fibrous bands from the orbital septum pass through the orbicularis oculi and insert into the skin, forming an inferior palpebral. Complications of eyelid reconstruction using a semicircular flap. Single tarsoconjunctival flap lower eyelid for upper. Upper lid tissue used for lower lid reconstruction includes the hughes flap which shares a part of the upper lid tarsal plate and conjunctiva.
Full thickness skin grafts in periocular reconstructions. In 1975, tenzel described a modified lateral, semicircular advancementrotation flap for the reconstruction of upper and lower eyelid defects. He proposes a new technique for reconstruction of fullthickness lower eyelid defects, such as. The most difficult part of this surgery is to create a lid plate eyelid above the lashes from regular lid skin. The end goal of eyelid reconstruction is both functional and aesthetic restoration of the eyelid and periocular area while minimizing surgical morbidity. Basal cell carcinoma bcc is the second most common cause for eyelid reconstruction. Reconstruction of fullthickness lower eyelid defects. At the recent meeting of the american academy of facial plastic and reconstructive surgery in washington, dc, theodore staahl, modesto, calif, presented a method for reconstruction of the lower eyelid. Douglas, tina li, robert alan goldberg, norman shorr.
Classification of lower eyelid defects has previously focused on the missing horizontal percentage of the lid. Aesthetic total lower eyelid reconstruction springerlink. Principles and techniques of eyelid reconstruction. One hundred consecutive caucasian patients were included in the study, 54 women and 46 men. Mustarde cheek rotation flap for lower eyelid repair. Reconstructive eyelid surgery gallery philadelphia pa. Lower eyelid reconstruction by tarsal transposition.
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