Lateral tarsal strip through osteotomies for recurrent ectropion and eyelid laxity correction

2022 ◽  
pp. 112067212110730
Author(s):  
Amparo M Mora ◽  
Carlos M Córdoba ◽  
Fabio D Padilla ◽  
Diego F Duran
Keyword(s):  
Surgical Technique ◽  
Facial Asymmetry ◽  
Lower Eyelid ◽  
Body Sensation ◽  
Alternative Treatment Option ◽  
Initial Symptoms ◽  
Aesthetic Results ◽  
Lateral Tarsal Strip ◽  
Anophthalmic Socket

Objective to present a surgical technique for treating patients with recurrent ectropion and severe lower eyelid laxity. Methods Lateral tarsal strip and canthal fixation by osteotomy was performed in 6 patients with recurrent ectropion and 1 patient with extreme lower eyelid laxity secondary to an anophthalmic socket. Preoperative and postoperative photographs were evaluated in order to assess the outcomes of the procedure. Patients were followed up 4 weeks, 6 months, 12 months and 24 months of the postoperative period. The initial symptoms of the patients were eye redness, epiphora, foreign body sensation, aesthetic complaints, and facial asymmetry. Symptoms and aesthetic results were assessed by questioning, photographs, and fluorescein and lissamine green stains taken in each visit. Results No postoperative complications were observed. No recurrence episodes were reported during the follow-up period and physical appearance improvement and symptom severity reduction were maintained during the observation. Conclusion Lateral tarsal strip through osteotomies is an effective surgical procedure for treating severe recurrent ectropion cases or lower eyelid laxity and could be considered as an alternative treatment option or even a primary surgical technique in selected difficult cases.

scholarly journals Objective Comparison of Nasojugal Fold Depth and Lower Eyelid Length After Fat Excision Versus Fat Transpositional Lower Blepharoplasty

2019 ◽  
Vol 39 (10) ◽  
pp. 1048-1054 ◽  
Author(s):  
Sathyadeepak Ramesh ◽  
Robert A Goldberg ◽  
Allan E Wulc ◽  
Alan B Brackup
Keyword(s):  
Retrospective Review ◽  
Lower Eyelid ◽  
Level Of Evidence ◽  
Aesthetic Result ◽  
Lower Blepharoplasty ◽  
The World ◽  
Aesthetic Results ◽  
Compare And Contrast

AbstractBackgroundLower blepharoplasty is one of the most commonly performed aesthetic surgeries in the world. However, there are no studies to directly compare patients who had fat excision vs fat transposition.ObjectivesThe authors sought to compare and contrast aesthetic results of fat excisional and fat transpositional lower blepharoplasty.MethodsA retrospective review was conducted of 60 patients (120 eyelids) who underwent transconjunctival lower blepharoplasty, either with fat excision or fat transposition into a preperiosteal plane. Marginal reflex distance-2, lower eyelid length, nasojugal fold depth, and pretarsal orbicularis definition were measured.ResultsMean follow-up was 5.6 months. Mean marginal reflex distance-2 did not significantly differ after either fat excision or fat transposition. Mean lower lid length decreased after fat excision only (P < 0.001), and postoperative fat excision patients had a shorter lower eyelid length than patients who underwent fat transposition (13.5 ± 2.1 mm vs 16.1 ± 1.9 mm, P < 0.0001). Pretarsal orbicularis definition increased after both surgeries (P < 0.001), and the groups did not differ (1.0 ± 0.8 vs 1.1 ± 0.9, not significant). Mean nasojugal fold depth was effaced after surgery in both groups (P < 0.001), although the nasojugal fold was significantly more effaced after fat transposition (1.5 ± 0.7 vs 0.48 ± 0.6, P < 0.001).ConclusionsIn lower blepharoplasty, fat excision resulted in a shorter lower eyelid, and fat transposition resulted in a more effaced lid-cheek junction. Surgeons should be able to balance both techniques to deliver a customized aesthetic result.Level of Evidence: 3

scholarly journals Patient-Specific Implant for Residual Facial Asymmetry following Orthognathic Surgery in Unilateral Craniofacial Microsomia

2016 ◽  
Vol 9 (3) ◽  
pp. 264-267 ◽  
Author(s):  
Femke Staal ◽  
Britt Pluijmers ◽  
Eppo Wolvius ◽  
Maarten Koudstaal
Keyword(s):  
Orthognathic Surgery ◽  
Facial Asymmetry ◽  
The Body ◽  
Patient Specific ◽  
Clinical Report ◽  
Prominent Feature ◽  
Craniofacial Microsomia ◽  
Aesthetic Results ◽  
Variable Phenotype

Craniofacial microsomia (CFM) is a congenital anomaly with a variable phenotype. The most prominent feature of CFM is a predominantly unilateral hypoplasia of the mandible, leading to facial asymmetry. Even after correction of the midline, there is often a remaining hard- and soft-tissue deficiency over the body of the mandible and cheek on the affected side. This clinical report describes the skeletal augmentation of the mandible with a patient-specific implant to treat residual facial asymmetry in two female patients with unilateral CFM. Good aesthetic results were achieved in both patients treated with either a Medpor or polyetheretherketone implant without complications after a follow-up time of 55 and 30 months, respectively.

scholarly journals Az alsó szemhéj pótlása tumoreltávolítás után

2021 ◽  
Vol 162 (29) ◽  
pp. 1180-1184
Author(s):  
Zoltán Sohajda ◽  
Levente Juhász
Keyword(s):  
Wound Dehiscence ◽  
Lower Eyelid ◽  
Early Postoperative Period ◽  
Cosmetic Result ◽  
Full Thickness ◽  
Tumor Removal ◽  
Eyelid Reconstruction ◽  
Lower Eyelid Reconstruction ◽  
Aesthetic Results

Összefoglaló. Bevezetés: A tumoreltávolítás miatt végzett teljes alsószemhéj-pótlás összetett feladat lehet. A rekonstrukció célja a kielégítő funkcionális és kozmetikai eredmény elérése. Célkitűzés: A módosított Fricke-lebennyel végzett rekonstrukció tapasztalatainak bemutatása az alsó szemhéj teljes hiánya esetén. Módszer: 2010. január és 2020. december között 7 beteg esetében tumoreltávolítás után végeztünk alsószemhéj-rekonstrukciót módosított Fricke-lebennyel. A lebeny képzése a halántéktájon történt. A betegek átlagéletkora 72,8 év volt. A szövettani eredmény minden esetben basocellularis carcinoma volt. Az átlagos követési idő 1,9 év volt. Eredmények: Minden esetben jó funkcionális és esztétikai eredményt értünk el. Lebenynecrosist, sebelégtelenséget nem tapasztaltunk. A korai posztoperatív szakban átmeneti conjunctiva- és szemhéjoedema volt tapasztalható. 3 beteg esetében könnyezés, 1 beteg esetében érintő szőrök okozta szemszúródást észleltünk. Recidíva nem alakult ki a követési idő alatt. Következtetés: Tapasztalataink szerint a módosított Fricke-lebeny kiváló funkcionális és esztétikai eredményt ad a tumoreltávolítás utáni teljes alsószemhéj-rekonstrukcióban. Orv Hetil. 2021; 162(29): 1180–1184. Summary. Introduction: The full-thickness lower eyelid reconstruction after tumor removal can be a complex challenge. The aim of reconstruction is to reach an appropriate functional and cosmetic result. Objective: To present the retrospective analysis of the reconstruction’s experience with the use of Fricke’s flap in the case of full-thickness lower eyelid defect. Method: Between January 2010 and December 2020, in the case of 7 patient’s after tumor excision on lower eyelid, reconstruction was performed with a modified Fricke’s flap. The Fricke’s flap was fashioned in the temple region. The patients’ average age was 72.8 years. The histological result was basocellular carcinoma in every case. The average follow-up period was 1.9 years. Results: In all cases, good functional and cosmetic result was detected. There were not any flap necrosis and wound dehiscence. In the early postoperative period, temporary edema of the eyelid and conjunctiva was detected. Epiphora occurred in the case of 3 patients and we observed eye irritation caused by skin hair in the case of 1 patient. Tumor recurrence was not detected during the follow-up period. Conclusion: In our experience, the modified Fricke’s flap has excellent functional and aesthetic results in the reconstruction after tumor removal on the lower eyelid. Orv Hetil. 2021; 162(29): 1180–1184.

scholarly journals Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

2015 ◽  
Vol 16 (1) ◽  
pp. 86-93 ◽  
Author(s):  
Marie-Lise C. van Veelen ◽  
Dalibor Mihajlović ◽  
Ruben Dammers ◽  
Hester Lingsma ◽  
Leon N. A. van Adrichem ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Head Circumference ◽  
Linear Regression Analysis ◽  
Sagittal Synostosis ◽  
Time Points ◽  
Aesthetic Results ◽  
The Aesthetic ◽  
The Impact ◽  
Over Time

OBJECT Various techniques to correct sagittal synostosis have been described. The authors of this study assess the results of 2 techniques for late complete cranial remodeling and test the hypothesis that adding a widening bridge would improve outcome. METHODS In this retrospective study, the authors evaluated patients with nonsyndromic sagittal synostosis—those who underwent frontobiparietal remodeling (FBR) and those who underwent modified FBR (MFBR) involving the introduction of a bony bridge to increase the width of the skull. Outcomes for both groups are described in terms of the aesthetic results assessed on photographs and any changes in the cranial index (CI) and head circumference over time, the presence of papilledema, and complaints of headache. The effect of the surgical technique on CI and head circumference over time was assessed using linear regression analysis, with adjustment for preoperative CI and head circumference. RESULTS Sixty-nine patients with isolated sagittal synostosis were included in this study: 35 underwent MFBR and 34 underwent the original technique of FBR. The mean follow-up period was 7 years. In the 1st year after surgery, mean CI improved by 9% in the FBR group and by 12% in the MFBR group. One year after surgery, CI in the MFBR group was on average 4.7% higher than that in the FBR group (p < 0.001). During follow-up, CI decreased in both groups; however, at all time points CI was significantly higher in the MFBR group than in the FBR group. The impact of surgical technique on CI was less important than the impact of preoperative CI (R2= 0.26 vs 0.54), and this applied at all time points during follow-up. Head circumference declined during follow-up in both groups. It was influenced by preoperative head circumference, but not by surgical technique. Aesthetic outcome, prevalence of headache (42%), and papilledema (7%) were comparable in both groups. CONCLUSIONS Adding a widening bridge to late complete remodeling significantly improved CI and helped to prevent CI from decreasing in the long term. This addition did not affect the head circumference growth curve. Despite a mean head circumference remaining at +1 SD, patients continued to develop papilledema postoperatively (7%).

scholarly journals Shallow Inferior Conjunctival Fornix in Contracted Socket and Anophthalmic Socket Syndrome: A Novel Technique to Deepen the Fornix Using Fascia Lata Strips

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Mohamed F. K. Ibrahiem ◽  
Sahar T. A. Abdelaziz
Keyword(s):  
Lower Eyelid ◽  
Fascia Lata ◽  
Controlled Study ◽  
Control Group ◽  
Contracted Socket ◽  
Eyelid Malposition ◽  
Skin Scar ◽  
Inferior Fornix ◽  
Anophthalmic Socket

Purpose.To evaluate a new surgical technique using fascia lata to deepen the shallow inferior conjunctival fornix in contracted socket and anophthalmic socket syndrome.Methods.A prospective controlled study in which 24 sockets of 24 patients who were unable to wear and retain their ocular prosthesis due to shallow inferior fornix were enrolled and categorized into anophthalmic socket syndromes (9 patients) and contracted sockets (15 patients). Another 24 patients who underwent evisceration or enucleation with healthy sockets and can wear and retain their prosthesis comfortably were chosen as a control group. Deepening of the fornix was performed using fascia lata strips under general anesthesia. Central depth of the inferior fornix was measured preoperatively and postoperatively.Results.A statistically significant improvement of the postoperative central inferior fornix depth was reported which was marked in anophthalmic subgroup. 100% of anophthalmic sockets and 93.3% of contracted sockets achieved satisfactory results during the follow-up period with no postoperative lower eyelid malposition or obvious skin scar.Conclusion.Fascia lata technique is a new alternative and effective procedure to deepen the shallow inferior fornix that can be used in moderate to severe contracted sockets or anophthalmic socket syndrome with minimal lower eyelid or socket complications.

The effects of using spacer grafts on lower-eyelid retraction surgery in patients with facial nerve palsy

2021 ◽  
pp. 112067212110519
Author(s):  
Mi Jin Kim ◽  
Yong Min Choi ◽  
Namju Kim ◽  
Ho-Kyung Choung ◽  
Sang In Khwarg
Keyword(s):  
Facial Nerve ◽  
Surgical Outcomes ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Lower Eyelid ◽  
Interquartile Range ◽  
Eyelid Retraction ◽  
Subgroup Analyses ◽  
Lateral Tarsal Strip

Purpose To evaluate the effects of the concomitant use of spacer grafts in lateral tarsal strip surgery in patients with facial nerve palsy-related lower-eyelid retraction. Methods Patients who underwent lateral tarsal strip surgery to correct facial nerve palsy-related lower-eyelid retraction were retrospectively reviewed. Postoperative decreases in marginal reflex distance-2 values at 1, 2 and 6 months were measured along with the effects of spacer grafts. Results Forty-five patients (28 males) were included (mean age: 59.56 years). Mean preoperative marginal reflex distance-2 was 6.87 ± 1.34 mm. Twenty patients underwent lateral tarsal strip surgery only (lateral tarsal strip-only); 25 patients underwent lateral tarsal strip surgery using spacer grafts (lateral tarsal strip + graft). Median (interquartile range) follow-up duration was 12.0 (6.0–23.0) months. Retraction was significantly improved and maintained at 1, 2 and 6 months postoperatively in all patients (mean marginal reflex distance-2: 3.78 ± 1.06 mm, 4.30 ± 1.23 mm and 4.72 ± 1.11 mm, respectively). Surgical outcomes were significantly better in the lateral tarsal strip + graft than in the lateral tarsal strip-only group (Δmarginal reflex distance-2: 3.92 vs. 2.05 mm at 1 month, p < 0.001; 3.38 vs. 1.61 mm at 2 months, p = 0.001; 2.88 vs. 1.69 at 6 months, p = 0.042). Subgroup analyses by spacer graft type revealed no significant differences. Conclusion The concomitant use of spacer material in lateral tarsal strip surgery yielded better surgical outcomes than lateral tarsal strip surgery alone. The use of spacer grafts should be considered for correcting severe facial nerve palsy-related lower-eyelid retraction.

scholarly journals Alei II Technique: Minimally Invasive Technique for the Correction of Penile Curvature without Circumcision

2016 ◽  
Vol 9 (1) ◽  
pp. 70-70
Author(s):  
P. Letizia ◽  
◽  
G. Alei ◽  
A. Rossi ◽  
◽  
...  
Keyword(s):  
Surgical Technique ◽  
Sagittal Plane ◽  
Peyronie’S Disease ◽  
Invasive Technique ◽  
Penile Curvature ◽  
Penile Deviation ◽  
Aesthetic Results ◽  
Peyronie's Disease ◽  
New Surgical Technique

Objective: We describe a new surgical technique for the treatment of penile curvature. In 2012, we developed a new surgical technique for the correction of congenital and acquired penile curvature without circumcision called “track” corporoplasty or Alei II technique Design and Method: For the penile ventral curvature repair an infrapubic transverse dorsal incision is made to correct a ventral curvature or when removing or cutting the plaque in Peyronie’s disease A single 0 non-absorbable synthetic multifilament suture is placed in order to perform a special placation on two parallel lines and therefore called “track”. Laterally to the corporoplasty described, two corporoplasties should be performed along the line that goes from the dorsal neurovascular bundle to the lateral end of the corpus cavernosus at 30° and 60° on the penile sagittal plane. The two corporoplasties should measure 50% at 30° and 25% at 60. Results: Mean age was 43 years for patients with Peyronie’s disease and 31 years for patients with congenital penile deviation. The mean follow-up period was 36 months. No major complications, no circumcision, overall satisfaction 98%. Intraoperative correction of the curvature was achieved in 100%, significant relapse occurred in 2%. Conclusions: This original technique is associated with low morbidity, low recurrence rate and excellent aesthetic results.

scholarly journals Vertical-to-Horizontal Rotational Myocutaneous Flap for Repairing Cicatricial Lower Lid Ectropion: A Novel Surgical Technique

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Yu-Fan Chang ◽  
Chieh-Chih Tsai ◽  
Hui-Chuan Kau ◽  
Catherine Jui-Ling Liu
Keyword(s):  
Surgical Technique ◽  
Myocutaneous Flap ◽  
Lower Eyelid ◽  
Functional Improvement ◽  
Cosmetic Appearance ◽  
Flap Procedure ◽  
Free Skin Graft ◽  
Cicatricial Ectropion ◽  
Horizontal Eyelid Laxity

Objective. To evaluate the efficacy and complications of a novel surgical technique for cicatricial lower lid ectropion that uses a vertical-to-horizontal (V-to-H) rotational myocutaneous flap procedure (Tsai procedure). Methods. We performed the V-to-H rotational myocutaneous flap procedure on 20 eyelids in 20 patients with mild to moderate cicatricial lower lid ectropion. A vertical myocutaneous flap was created from the anterior lamella of the vertical pedicle in the lateral third of the lower eyelid. Following a horizontal relaxing incision from the base of the flap, a vertical myocutaneous flap was created and rotated to horizontal. Two patients with combined cicatricial ectropion and paralytic lagophthalmos simultaneously underwent additional lateral tarsorrhaphy. Results. After a minimum follow-up period of 6 months, all patients showed good anatomical and functional improvement with decreased dependence on topical lubricants and a satisfactory cosmetic appearance. Two patients with combined cicatricial and paralytic ectropion had mild residual asymptomatic lagophthalmos. No patients required further revision surgery and there were no complications or recurrence. Conclusion. The V-to-H rotational myocutaneous flap technique was an effective and simple one-stage procedure for correcting cicatricial lower lid ectropion. It lengthened the anterior lamella and tightened horizontal eyelid laxity without the need for a free skin graft.

A retrospective study of tailored surgery based on the mechanical balance principle for involutional entropion in the lower eyelid

2020 ◽  
pp. 112067212098439
Author(s):  
Jian Hu ◽  
Yueyue Li ◽  
Qian Li ◽  
Liqiang Wang ◽  
Yifei Huang
Keyword(s):  
Retrospective Study ◽  
Wedge Resection ◽  
The Elderly ◽  
Lower Eyelid ◽  
Recurrence Rates ◽  
Balance Principle ◽  
Involutional Entropion ◽  
Balance Analysis ◽  
Lateral Tarsal Strip

Objective: Involutional entropion in the lower eyelid is one of the most common eyelid disorders of the elderly. Despite the effectiveness of the widely used surgical procedures, recurrence rates have failed to improve. In this retrospective study, we aimed to assess surgical plans, effectiveness and safety of tailored surgery based on the mechanical balance principal in treating involutional entropion in the lower eyelid. Methods: A retrospective analysis of 47 patients (54 eyelids) diagnosed with involutional entropion in the lower eyelid and receiving tailored surgical treatment based on mechanical balance principle from 1 January 2016 to 31 December 2018 was carried out. Tailored surgical plans were developed according to the mechanical balance analysis of vertical, horizontal and sagittal directions. Results: All 54 eyelids with involutional entropion in the lower eyelid underwent advancement of the lower eyelid retractor (LER) through the conjunctiva. For patients with mild horizontal eyelid laxity, only LER advancement was performed. For moderate and severe horizontal eyelid laxities, combined horizontal reinforcement procedures were performed, including lateral canthopexy, lateral tarsal strip (LTS) surgery and wedge resection. The orbicularis oculi muscle (OOM) tightening or transposition was performed for OOM overriding. The follow-up time was 1 to 4 years, and there were no cases experiencing recurrence. Thus, the rates of effectiveness and recurrence were 100% and 0%, respectively. Conclusions: This is the first descriptive study on the tailored surgical strategies designed according to the mechanism of mechanical imbalance involved in involutional entropion. Tailored surgery based on the mechanical balance principle is safe and effective with low recurrence.

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