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Buccal mucosal membrane graft for correction of cicatricial lower eyelid retraction. BMC Ophthalmol 2022; 22:465. [PMID: 36457092 PMCID: PMC9714222 DOI: 10.1186/s12886-022-02699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To evaluate the outcomes of a surgical technique using buccal mucosal membrane graft for correction of cicatricial lower eyelid retraction. METHODS Twelve patients with unilateral cicatricial lower eyelid retraction were enrolled in the study. All patients underwent a four-step surgical technique consisted of release of scars, midface lift, transfer of buccal mucosal membrane to posterior lamella as spacer graft, and canthal tightening. All patients were followed for at least 12 months. RESULTS Mean preoperative Margin-to-Reflex-Distance 2 (MRD2) was 7.73 ± 1.10 mm, compared to mean postoperative MRD2 of 5.04 ± 0.49 mm (P < 0.0001). The mean improvement in retraction was 2.69 mm. Postoperative scleral show was present in only one case and no major complications were observed. CONCLUSION The four-step procedure (scar release, midface lift, buccal mucosal graft and canthal tightening) was an effective procedure to correct cicatricial lower eyelid retractions with acceptable outcomes and a low morbidity rate.
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Combined Dermis Spacer Graft, Lateral Canthopexy and Subperiosteal Midface Lifting in the Management of Lower Eyelid Retraction Secondary to Chronic Facial Nerve Palsy. J Maxillofac Oral Surg 2022. [DOI: 10.1007/s12663-022-01688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Wang Y, Holds JB, Douglas RS, Massry GG. The Spectrum of Aesthetic Canthal Suspension. Facial Plast Surg Clin North Am 2021; 29:275-289. [PMID: 33906760 DOI: 10.1016/j.fsc.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aesthetic canthal suspension can be an effective adjunct to lower eyelid blepharoplasty. Understanding the anatomy and function of the lateral canthal tendon is critical for preoperative evaluation and surgical decision making. In this article, the authors discuss the lateral canthal terminology, anatomy, and aging changes. Various canthal suspension procedures, including open and closed canthal suspension, commissure sparing open canthoplasty, and canthopexy, are described. Finally, the preoperative evaluation, postoperative course, and complications of surgery are reviewed.
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Affiliation(s)
- Yao Wang
- Beverly Hills Ophthalmic Plastic and Reconstructive Surgery, 150 North Robertson Boulevard #314, Beverly Hills, CA 90211, USA; Department of Plastic Surgery, Division of Oculoplastic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - John B Holds
- Ophthalmic Plastic and Cosmetic Surgery, Inc., 12990 Manchester Road, #102, St. Louis, MO 63131, USA
| | - Raymond S Douglas
- Beverly Hills Ophthalmic Plastic and Reconstructive Surgery, 150 North Robertson Boulevard #314, Beverly Hills, CA 90211, USA; Department of Plastic Surgery, Division of Oculoplastic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Guy G Massry
- Beverly Hills Ophthalmic Plastic and Reconstructive Surgery, 150 North Robertson Boulevard #314, Beverly Hills, CA 90211, USA; Department of Plastic Surgery, Division of Oculoplastic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA; Department of Ophthalmology, Division of Oculoplastic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Patel A, Wang Y, Massry GG. Management of Postblepharoplasty Lower Eyelid Retraction. Facial Plast Surg Clin North Am 2019; 27:425-434. [DOI: 10.1016/j.fsc.2019.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Galindo-Ferreiro A, Fernandez E, Weill D, Zornoff DCM, Khandekar R, Corrente JE, Schellini SA. A Web-Based Survey of Oculoplastic Surgeons Regarding the Management of Lower Lid Retraction. Semin Ophthalmol 2019; 34:125-130. [DOI: 10.1080/08820538.2019.1596290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Estrella Fernandez
- Department of Ophthalmology, Hospital Clínic de Barcelona, Institut Clínic d‘Oftalmologia, Barcelona, Spain
| | - Daniel Weill
- Department of Ophthalmology, Facultad de Medicina de Buenos Aires, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Denise C M Zornoff
- Distance Education and Health Information Technology Center, Faculdade de Medicina de Botucatu, UNESP, Sao Paulo, Brazil
| | - Rajiv Khandekar
- Diagnostic Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Silvana A Schellini
- Department of Oculoplastics, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Ophthalmology Faculdade de Medicina de Botucatu, UNESP, São Paulo, Brazil
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Sales-Sanz M, Barrancos C, Won-Kim HR, Sales-Sanz A, Colmenero C. Reconstructive subperiosteal midface lift: A three nonvisible incision approach. Orbit 2017; 36:256-263. [PMID: 28678580 DOI: 10.1080/01676830.2017.1337166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/28/2017] [Indexed: 06/07/2023]
Abstract
This article describes our surgical technique for subperiosteal midface elevation in patients with paralytic lower eyelid malposition or cicatricial inferior eyelid retraction. Nineteen patients with paralytic lower eyelid malposition and 15 patients with cicatricial inferior eyelid retraction underwent a subperiosteal midface lift (n = 34). The procedure was performed under local anesthesia through three nonvisible incisions. A transconjunctival incision allows preseptal dissection to the orbital rim, followed by a subperiosteal dissection of the midface. An oral incision is useful to achieve complete subperiosteal dissection and to perform the distal periostomy, which allows complete release of the midface soft tissues. A temporal incision provides access to the temporal fascia for fixation of the elevated tissues and gives the surgeon the possibility of removing redundant skin from the scalp instead of the lower eyelid. Additional posterior lamellar grafting was performed in 24 patients. There was a statistically significant reduction in the distance from the pupil centre to the lower eyelid (margin reflex distance, MRD2) 1 month after surgery (preoperative MRD2 9.62 ± 4.52 mm, postoperative MRD2 5.28 ± 2.62 mm). The ectropion and lower eyelid retraction was resolved in all patients, except for one recurrence. Midfacial elevation is a safe and effective surgical technique in the treatment of static lower eyelid malposition after chronic facial nerve palsy or posttraumatic or iatrogenic lower eyelid retraction.
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Affiliation(s)
- Marco Sales-Sanz
- a Ophthalmology Department , Ramón y Cajal Hospital , Madrid , Spain
| | | | - Hae-Ryung Won-Kim
- a Ophthalmology Department , Ramón y Cajal Hospital , Madrid , Spain
| | - Andrea Sales-Sanz
- b Ophthalmology Department , Príncipe de Asturias Hospital , Alcalá , Spain
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Scawn RL, Joshi N. Commentary on: Lower Eyelid Retraction Surgery Without Internal Spacer Graft. Aesthet Surg J 2017; 37:140-142. [PMID: 28096116 DOI: 10.1093/asj/sjw244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Richard L Scawn
- From the Department of Oculoplastic and Craniofacial Surgery, Chelsea and Westminster Hospital, London, United Kingdom; and the Oculoplastic Service, Buckinghamshire NHS Trust, Aylesbury, United Kingdom.
| | - Naresh Joshi
- From the Department of Oculoplastic and Craniofacial Surgery, Chelsea and Westminster Hospital, London, United Kingdom; and the Oculoplastic Service, Buckinghamshire NHS Trust, Aylesbury, United Kingdom
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Abstract
This article describes a surgical technique using drill holes through the inferior orbital rim and fixation with permanent sutures as a functional subperiosteal midface lift and compares it to other standard midface elevation techniques. This was a retrospective, comparative, non-randomized study. Charts of all patients undergoing midface elevation between 2009 and 2013 were reviewed. Pre- and post-operative photos were graded on a scale 0 to 3 with 0 representing normal lower lid position and lid/cheek junction and 3 representing the most severe malposition. Twenty-seven patients (35 sides) underwent midface lift. Twelve sides had the subperiosteal drill hole midface lift; 9 preperiosteal with Vicryl suture fixation to periosteum; 14 subperiosteal with Endotine midface B device. All groups had similar demographics and indications for surgery. Average follow-up time was greater than 4 months in all groups. No significant complications were seen in any of the patients. The average post-operative grade of the drill hole group was 0.65 compared to 0.75 of the preperiosteal Vicryl group and 0.7 of the Endotine group. The drill hole group had the most severe pre-operative malposition. Overall, the drill hole group demonstrated the largest improvement score. The subperiosteal drill hole technique proved to be an effective method for functional midface elevation. This technique achieves adequate and durable vertical elevation without relying on the strength of the periosteum or use of a commercial device.
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Affiliation(s)
- C Blake Perry
- a Department of Ophthalmology and Visual Sciences , University of Iowa Hospitals and Clinics , Iowa City , Iowa , USA
| | - Richard C Allen
- a Department of Ophthalmology and Visual Sciences , University of Iowa Hospitals and Clinics , Iowa City , Iowa , USA
- b Department of Otolaryngology, Head and Neck Surgery , University of Iowa Hospitals and Clinics , Iowa City , Iowa , USA
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Perry CB, Allen RC. Repair of 50-75% full-thickness lower eyelid defects: Lateral stabilization as a guiding principle. Indian J Ophthalmol 2016; 64:563-7. [PMID: 27688276 PMCID: PMC5056542 DOI: 10.4103/0301-4738.191488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Repair of large defects of the lower eyelid can be difficult. A common procedure performed to address these defects is a Hughes flap. This procedure has a number of disadvantages: The eye is closed postoperatively, a second stage is required, and the edge of the flap is often erythematous. The purpose of this paper is to describe a one-stage procedure for the repair of large full-thickness defects of the lower lid as an alternative to a Hughes flap. Materials and Methods: This is a retrospective study of patients who underwent the described procedure. The procedure employs lateral stabilization of the posterior lamella with a periosteal strip, medial transposition of the lateral posterior lamella for central and medial defects, and a myocutaneous advancement flap to stabilize the anterior lamella. Results: A total of 38 patients underwent the procedure to reconstruct full-thickness defects of the lower lid ranging from 50% to 75%. All patients underwent previous Mohs excision of a skin cancer. The average follow-up was 5.6 months. Eleven patients (29%) had postoperative sequelae, but only two patients (5%) required additional treatment. Conclusion: Lateral stabilization with a periosteal strip and myocutaneous advancement flap is an excellent one-step procedure that avoids many of the complications seen with the Hughes procedure and is comparable to other techniques used for the reconstruction of subtotal, full-thickness lower lid defects.
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Affiliation(s)
- C Blake Perry
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Richard C Allen
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Injectable 5-FU with or without added steroid in periorbital skin grafting: initial observations. Ophthalmic Plast Reconstr Surg 2015; 31:122-6. [PMID: 25025385 DOI: 10.1097/iop.0000000000000214] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The authors describe their experience with postoperative injectable 5-fluorouracil (5-FU), with or without added low-dose and concentration steroid, in the particular patient subset undergoing eyelid skin grafting surgery. METHODS A retrospective chart review (2011-2013) of patients who underwent eyelid skin grafting for various etiologies with adjunctive postoperative 5-FU (50 mg/ml) injections (with or without added kenalog 5 mg/ml) was performed. Injections were given 2 to 3 weeks postsurgery and as frequently as every 2 weeks for a total of up to 4 injections. At each visit, patients were evaluated for redness, swelling, wound healing, scar formation, tissue inflammation/atrophy, telangiectasis, and pigmentary disturbances. Patient interpretation of outcome was determined subjectively by asking if they were satisfied and objectively by their separate responses to specific questions graded on a Likert-type scale. Operating surgeon satisfaction was determined only by subjective clinical evaluation of final results. Finally, a graded evaluation of pre- and postoperative digital photographs by an independent facial plastic surgeon was added to quantitatively evaluate the surgical results. RESULTS Nineteen patients with an average age of 66 years and follow up of 10 months are included. Surgical indications include reconstruction of cancer excision defects, repair of lower eyelid ectropion or retraction, benign eyelid lesion excision, and effacement of a canthal web. On average, patients had a total of 4 separate 0.3 to 0.5 ml 5-FU, or 5-FU/kenalog injections spaced 2 to 3 weeks apart. In 11 of 19 patients, the 5-FU injections were mixed with steroid. There were no cases of skin thinning, color/texture change, atrophy, telangiectasis, or infection after injection, and all patients had uneventful healing of their grafts. Eighty-nine percent of patients were satisfied with their outcome (graded 4.73/5) and the appearance of the skin graft (graded 4.79/5). In 95% of cases, the surgeon was satisfied with the surgical result. Independent surgeon assessment of outcome was graded (4.58/5). CONCLUSIONS A 5-FU or 5-FU/kenalog (75%/25%) mixture can be injected safely after eyelid skin grafting surgery. Surgical results are good with minimal scarring, high patient and surgeon satisfaction, and few complications. Results are equally efficacious and complication-free with or without the addition of a steroid component to the injection mixture.
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Avoiding and Managing Complications in the Periorbital Area and Midface. Facial Plast Surg Clin North Am 2015; 23:257-68. [DOI: 10.1016/j.fsc.2015.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Griffin G, Azizzadeh B, Massry GG. New insights into physical findings associated with postblepharoplasty lower eyelid retraction. Aesthet Surg J 2014; 34:995-1004. [PMID: 25168805 DOI: 10.1177/1090820x14544306] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Postblepharoplasty lower eyelid retraction (PBLER) has been linked to anterior lamellar shortage, unaddressed eyelid laxity, and middle lamellar scarring. The authors believe there are other, less-appreciated physical findings (orbicularis weakness, negative-vector eyelid, and inferior eyelid/orbit volume deficit) that also influence the development and potentially the management of this complex type of eyelid malposition. OBJECTIVES To better understand PBLER, potentially prevent its development, and improve treatment options, the authors determined the incidence of various physical findings present on initial examination of patients referred for PBLER revision. METHODS The medical charts of patients referred for PBLER revision over a 21-month period were reviewed. The presence of anterior lamellar shortage, lower eyelid laxity, and a middle lamellar (internal eyelid) scar was documented. Orbicularis weakness, negative-vector eyelid topography, and volume deficiency of the lower eyelid/inferior orbit also were noted. The incidence of each finding was calculated. RESULTS Forty-six patients (35 women, 11 men) were included. All patients had undergone primary transcutaneous surgery, which led to the eyelid retraction. Orbicularis weakness, anterior lamellar shortage, inferior eyelid/orbital volume deficit, negative-vector eyelid topography, and eyelid laxity were common. A middle lamellar scar of significance was found in only 17% of eyelids. CONCLUSIONS The data suggest that the aforementioned underappreciated findings are common in patients with PBLER. Evaluating these factors when planning primary blepharoplasty may reduce the incidence of PBLER. Awareness of these findings when planning revisional procedures may improve surgical outcomes. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Garrett Griffin
- Dr Griffin is a facial plastic surgeon in private practice in Woodbury, MinnesotaDr Azizzadeh is a facial plastic surgeon in private practice in Beverly Hills, CaliforniaDr Massry is an ophthalmic plastic surgeon in private practice in Beverly Hills, California
| | - Babak Azizzadeh
- Dr Griffin is a facial plastic surgeon in private practice in Woodbury, MinnesotaDr Azizzadeh is a facial plastic surgeon in private practice in Beverly Hills, CaliforniaDr Massry is an ophthalmic plastic surgeon in private practice in Beverly Hills, California
| | - Guy G Massry
- Dr Griffin is a facial plastic surgeon in private practice in Woodbury, MinnesotaDr Azizzadeh is a facial plastic surgeon in private practice in Beverly Hills, CaliforniaDr Massry is an ophthalmic plastic surgeon in private practice in Beverly Hills, California
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Alfano C, Chiummariello S, Monarca C, Scuderi N, Scuderi G. Lateral canthoplasty by the Micro-Mitek Anchor System: 10-year review of 96 patients. J Oral Maxillofac Surg 2011; 69:1745-9. [PMID: 21277065 DOI: 10.1016/j.joms.2010.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 07/29/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Lateral canthoplasty is useful to correct lower eyelid malposition, restore eyelid function, and protect the ocular surface. An effective method for fixation of soft tissue in the face, such as the lateral canthus, using the Micro-Mitek Anchor System is presented. PATIENTS AND METHODS We report our experience in 96 patients who underwent lateral canthoplasty by Micro-Mitek Anchor. One hundred twenty-four lateral canthoplasties were performed, including, senile ectropion, tumors, trauma, cicatricial retraction, and lower eyelid malposition after blepharoplasty. RESULTS The insertion of a bone anchor requires a limited dissection, and the insertion area can be determined accurately. Using the bone anchor to fixate the lateral canthus to the facial skeleton is an effective way to prevent drooping of the canthus due to gravitational forces. CONCLUSIONS Lateral canthoplasty using the Mitek Anchor System has the advantage of being an easy technique with accurate placement of the anchor, reducing operating time.
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Affiliation(s)
- Carmine Alfano
- Department of Plastic and Reconstructive Surgery, University of Perugia, Perugia, Italy
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