scholarly journals Lateral sliding flap for one-step reconstruction of medium-sized eyelid defects

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Dion Paridaens ◽  
Keyword(s):  
Operating Time ◽  
Case Series ◽  
Lower Eyelid ◽  
Advancement Flap ◽  
Eyelid Margin ◽  
Upper Eyelid ◽  
Reconstruction Methods ◽  
Lateral Canthus ◽  
One Step ◽  
Fair Poor

Background/purpose: To report the results of our clinical study on the efficacy of a ‘Lateral Sliding Flap’: A one-step technique for lower or upper eyelid reconstruction. Methods: Retrospective analysis of a consecutive case series of patients treated with a ‘Lateral Sliding Flap’ following tumour removal by horizontal block excision. In this technique a (medium-sized) defect of up to 50% of the eyelid was reconstructed by disinsertion of the lateral canthus, medial advancement of the lateral (remaining) (full-thickness) eyelid and a laterally-based horizontal skin-muscle advancement flap, followed by canthal fixation. We recorded the operating time and evaluated the postoperative eyelid apposition, lid contour, complications and frequency and type of re-operation. The outcome was scored (according to four grades (excellent/good/fair/ poor) of lid apposition and contour. Results: Seven consecutive patients, all treated by one oculoplastic surgeon in one year, were included. Six were female, one was male. Five had lower eyelid defects, two had upper eyelid defects of 40-50% of the horizontal width. The average age was 67,9 years, ranging from 52 to 85 years. The mean postoperative follow-up time was 31 months, ranging from 21-43 months. The average duration of the reconstruction was 31 minutes (ranging from 25 to 38 minutes). The outcome was excellent in 3 patients, good in 3 patients and fair in one patient. (Some) lash loss may be encountered. No complications such as flap ischemia of necrosis were noted. No re-operation was required. Conclusion: The ‘Lateral Sliding Flap’ is an efficaceous, one-step technique for reconstruction of defects of up to 50% of the lower or upper eyelid. With the technique a normal eyelid margin is created at the level of the cornea for optimal visual function and comfort. Compared to Tenzel’s semicircular rotation flap, the ‘lateral sliding flap’ results in a shorter vertical scar and “Hidden” horizontal scars in the relaxed skin tension lines.

scholarly journals The Use of Fascia Lata Free Graft for Lateral Canthus Reconstruction Following Mohs Lower Lid Surgery

Surgeries ◽  
2020 ◽  
Vol 1 (2) ◽  
pp. 77-81
Author(s):  
Rafal Nowak
Keyword(s):  
Lower Eyelid ◽  
Advancement Flap ◽  
Fascia Lata ◽  
Free Graft ◽  
Periosteal Flap ◽  
Lateral Canthus ◽  
Fascia Lata Graft ◽  
Free Skin Graft ◽  
Upper Lid ◽  
Lid Surgery

We present a case of a 75-year-old patient who underwent reconstruction of the lower eyelid and lateral canthus following removal of 80% of the lower eyelid due to basal cell carcinoma. A Hughes transconjunctival eyelid-sharing flap was used to form the posterior lamella, and a free skin graft from the ipsilateral upper lid was used to recreate the anterior lamella. The lateral canthal ligament was reconstructed using a free fascia lata graft. A periosteal flap was not used due to local scarring that was the result of previous multiple lateral canthal surgeries. Skin preservation in the lateral canthal area and additional horizontal support for the lower eyelid were achieved by using a local advancement flap. This two-stage surgery produced excellent functional and cosmetic effects. Fascia lata free graft can be an alternative to the periosteal flap for reconstruction of the lateral canthal ligament when use of the lateral orbital periosteum is not feasible.

Modified cheek advancement flap for medial lower eyelid, nasal sidewall and infraorbital cheek reconstruction: a case series

Orbit ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 123-127 ◽  
Author(s):  
Giorgio Albanese ◽  
Shivani Kasbekar ◽  
Lorraine C. Abercrombie
Keyword(s):  
Case Series ◽  
Lower Eyelid ◽  
Advancement Flap

Correction of Congenital Entropion of the Lower Eyelid: Incisional versus Rotational Surgery

2005 ◽  
Vol 15 (5) ◽  
pp. 536-540 ◽  
Author(s):  
M. Serafino ◽  
A. Bottoli ◽  
P. Nucci
Keyword(s):  
Pilot Study ◽  
Lower Eyelid ◽  
Low Risk ◽  
Eyelid Margin ◽  
Upper Eyelid ◽  
Cosmetic Results

Purpose When, at birth, the eyelid margin is rolled inward against the globe, the condition is referred to as congenital entropion. Upper eyelid involvement is commonly associated with a tarsal abnormality, while lower eyelid entropion is often associated with epiblepharon. Entropion does not resolve spontaneously, and may cause corneal pathology if untreated. The purpose of this study is to compare the two common techniques for the correction of congenital entropion. Methods The authors performed a pilot study of 24 consecutive patients with lower bilateral congenital entropion to compare the results of incisional versus rotational surgery. Results The rotational procedure was carried out in 14 patients; incisional surgery was performed in 10 patients. Twenty-one patients had good functional and cosmetic results. There were only three case of relapse after 3, 4, and 3 months. Conclusions The authors consider both techniques satisfactory, but the procedure of choice, considering the age of the patients and previous studies, remains rotational sutures because of its simplicity, quickness, and low risk of complication.

scholarly journals Orbital foreign body- Study of a case series

2015 ◽  
Vol 7 (1) ◽  
pp. 60-64
Author(s):  
S Dasgupta ◽  
V Vats ◽  
K S Mittal
Keyword(s):  
Traffic Accident ◽  
Road Traffic ◽  
Case Series ◽  
Lower Eyelid ◽  
Orbital Trauma ◽  
Orbital Cavity ◽  
Upper Eyelid ◽  
Surgical Exploration ◽  
First Case ◽  
History Of

Background: Orbital foreign bodies (OFBs) may remain in the orbital cavity for considerable time and manifest with secondary complications.Objective: To report five consecutive cases of orbital trauma with OFBs, who presented at our institute from Jan 2010 to Dec 2013. Cases: The first case of our series with a non-specific history of injury had a chronic granulomatous discharging sinus in the left upper eyelid and an intact globe. The second case, with an injury to the left lower eyelid following an assault, presented late and the manifestations were similar to that of the first case. The third case, of a road traffic accident, had sustained multiple facial and periocular injuries. The nature of all of three OFBs was uncertain by CT- scan, till surgical exploration. The fourth case had sustained injury to his left eye by a flying metal object. X-ray was sufficient to detect the OFB, but as scleral penetration was associated, management was complex. The fifth case had a nonspecific history of injury and the manifestation was similar to that of the first case. The surgical exploration revealed multiple OFB (wood). Conclusion: The OFBs pose difficult diagnostic and therapeutic challenges. Management of such cases, at times, calls for innovation in decision making and formulation of strategies.

scholarly journals Tail flap for eyelid reconstruction: An alternative to the Tenzel flap

2021 ◽  
pp. 21-28
Author(s):  
Golam Haider ◽  
Syeed Mehbub UI Kadir ◽  
Mukti Rani Mitra ◽  
Tanjila Hossain
Keyword(s):  
Reconstructive Surgery ◽  
Case Series ◽  
Lower Eyelid ◽  
Treacher Collins Syndrome ◽  
Juvenile Xanthogranuloma ◽  
Upper Eyelid ◽  
Eyelid Reconstruction ◽  
Triangular Flap ◽  
Case Series Study ◽  
Upper Lid

Purpose: To describe a technique of eyelid reconstruction with the tail flap method and also to evaluate the post-surgical outcome in a group of patients. Methods: This was a prospective case series study on nine patients who had undergone an eyelid reconstruction with the tail flap method. The study had been conducted from July 2014 to July 2019. The follow-up continued for six months to one year. Results: A total of nine patients with ten eyelid defects, 2 (22%) patients had unilateral eyelid coloboma, 1 (11%) had lower lid defect associated with Treacher-Collins syndrome,1 (11%)with bilateral upper eyelid coloboma, only one eyelid undergone lid reconstructive surgery associated with craniofacial anomalies,1 (11%) with Juvenile xanthogranuloma of the left upper eyelid,1(11%) with Basal cell carcinoma in the right upper lid, 3(34%) with Meibomian gland carcinoma 2 in lower eyelid and 1 in upper lid undergone lid reconstructive surgery with triangular flap. Among nine patients, a total of ten eyelid defects were repaired with the triangular flap technique, 5 (50%) in the upper eyelid and 5 (50%) in the lower eyelid. The eyelid defects were completely repaired with tail flap in all patients. All patients were evaluated preoperatively and postoperatively. The cosmetic outcomes of surgical intervention were excellent in 5(50%) cases, good in 3(30%) cases, fair enough in 2(20%) cases. Conclusions: Tail flap is an alternative surgical method to the well-established Tenzel flap in eyelid reconstruction. Keywords: Tail Flap; Tenzel Flap; Eyelid Defect; Lid reconstruction

scholarly journals Bilateral primary eyelid meibomian gland epithelioma in a dog: a case report

2019 ◽  
Vol 70 (1) ◽  
pp. 1435
Author(s):  
A. KOMNENOU ◽  
G. CHARALAMBIDOU ◽  
S. MAKROGKIKAS ◽  
N. PAPAIOANNOU
Keyword(s):  
Lower Eyelid ◽  
Meibomian Gland ◽  
Surgical Removal ◽  
Upper Eyelid ◽  
Palpebral Conjunctiva ◽  
Lateral Canthus ◽  
Tarsal Glands ◽  
The Right ◽  
Left Eyelid ◽  
Periorbital Swelling

In this paper an extremely rare case of primary bilateral eyelid meibomian gland epithelioma in a dog is presented. Meibomian tumors arise from the meibomian (tarsal) glands on the inner aspect of the eyelid, and meibomian gland adenomas and adenocarcinomas are the most frequent neoplasia arising from those glands. A 10-year-old male dog was admitted, with ophthalmic signs of periorbital swelling of the right eye. During the last two years, the dog had a progressive engorgement of the upper eyelid of the right eye, and during the past few months, strabismus and exophthalmos were also noticed, as well as a slighter enlargement on the lower eyelid of the left eye. Upon ophthalmic examination strabismus and periorbital swelling at the lateral canthus of the right eye, accompanied by mild exophthalmos and lagophthalmos, were recorded. Also, deep ulcerative keratitis with corneal oedema and neovascularization were noticed. Intense chemosis, epiphora and a small pinkish mass arising from the palpebral conjunctiva of the left lower eyelid were also seen. Neoplasia of both eyelids was suspected, and a series of diagnostic examinations were carried out. Orbital exenteration of the right eye was performed in the first place, followed by surgical removal of the mass of the left eyelid one month later. Based on clinical and histopathological findings, meibomian gland epithelioma was diagnosed. No relapse or metastases (local or distant) were observed in re-examinations within 18 months after the surgery. This study shows that although meibomian gland epithelioma is rare, it should be considered in the differential diagnosis of cases of orbital and eyelid tumors. Even though this tumor shows low malignancy, prompt surgical intervention and extended excision is the treatment of choice, in order to preserve vision in some cases. To the authors’ knowledge, the present case is the first report of bilateral meibomian gland epithelioma in the veterinary literature.

Correction of paralytic lagophthalmos

Folia Medica ◽  
2012 ◽  
Vol 54 (1) ◽  
pp. 24-29
Author(s):  
George E. Anastassov ◽  
Regina H. Khater ◽  
Yourii K. Anastassov
Keyword(s):  
Lower Eyelid ◽  
Technical Note ◽  
Temporalis Muscle ◽  
Temporalis Fascia ◽  
Eyelid Margin ◽  
Upper Eyelid ◽  
Muscle Transfers ◽  
Conchal Cartilage Graft ◽  
Gold Weights

ABSTRACT INTRODUCTION: Bell’s palsy causes lagophthalmos of the involved eyelids. Secondary to the atonicity of the eyelids, xerophthalmia, conjunctivitis and epiphora develops. There are dynamic (muscle transfers) and static (gold weights, tarsorrhaphy) approaches to alleviate these problems. The GOALS of this study are to present a technical note for a surgical method for lengthening the retracted upper eyelid with autogenous temporalis fascia and elevation of the lower eyelid with transplantation of autogenous morselized conchal cartilage graft via standard blepharoplasty incisions. MATERIAL AND METHODS: The proposed technique is illustrated in details with an example of a patient with paralytic lagophtalmos. The 4 years follow up of the case operated by this technique shows a stable occlusion of the eyelids with a lowering of the upper eyelid and elevation of the lower eyelid margin. CONCLUSION: If the paralysis is complete this technique will not accomplish adequate relieve of symptoms. In this cases re-animation of the eyelids with either temporalis muscle transfers or free micro neurovascular muscle transfers are indicated.

A Newly Modified Technique for Levator Muscle Tucking in Blepharoptosis Surgery: An Egyptian Tertiary Center Study

2021 ◽  
Author(s):  
Mahmoud Ahmed ELSamkary ◽  
Maged Maher Roshdy ◽  
Marwa Ahmed Abdel Karim
Keyword(s):  
Patient Satisfaction ◽  
Functional Outcome ◽  
Operating Time ◽  
Levator Muscle ◽  
Ocular Motility ◽  
University Hospitals ◽  
Modified Technique ◽  
Eyelid Margin ◽  
Upper Eyelid ◽  
Tertiary Center

Abstract Background: To highlight a newly modified technique for levator muscle tucking for the management of mild to moderate blepharoptosis.Methods: A prospective single-centre study enrolling 180 patients with blepharoptosis at Ain Shams University Hospitals from March 2017 to February 2019. Patients of unilateral or bilateral mild to moderate ptosis with good levator function (more than 8 mm) were included. Those with severe, traumatic, recurrent, mechanical ptosis, Marcus–Gunn jaw winking syndrome, third nerve palsy, absent Bell’s phenomenon, or abnormal ocular motility were excluded. The follow-up was at one week, one month, three months, six months, and one year visits. Functional outcome was assessed by analysis of the upper eyelid margin position in relation to the superior limbus and classified as very good (2 mm), good (2–4 mm), poor (5 mm) and preoperative to postoperative difference in marginal reflex distance (MRD). The aesthetic outcome was assessed in the form of symmetry of eyelid height, lid contour, lid crease presence, and degree of patient`s postoperative satisfaction.Results: The newly modified technique of levator tucking had a success rate of 92.1% in the form of a very good (77.7%) and good (14.4%) functional outcome, with highly acceptable aesthetic outcomes: symmetry of eyelid height in unilateral cases (86.1%) and bilateral cases eye (84%), lid contour regularity (91.6%) and lid crease symmetry (88.8%). Postoperative patient satisfaction was 83%, with a short operating time of 27.4 ± 4.6 minutes per eye.Conclusion: The newly modified technique of levator tucking is a rapid, simple, highly effective technique, with less recurrence and high patient satisfaction.Trial Registration:· Trial registry: ClinicalTrials.gov· Unique identifying number: NCT04883853· Date of registration: 11/5/2021 (retrospectively registered).

scholarly journals Total and Near Total Composite Lower Eyelid Defect Reconstruction with Glabella Flap: An Excellent Option with Limited Donor Site Availability

2021 ◽  
Vol 24 (4) ◽  
pp. 413-418
Author(s):  
Muhammad Omar Afzal ◽  
Yawar Sajjad ◽  
Kamran Khalid ◽  
Moazzam Nazeer Tarar
Keyword(s):  
Donor Site ◽  
Graft Infection ◽  
Case Series ◽  
Lower Eyelid ◽  
Total Loss ◽  
Cartilage Graft ◽  
Full Thickness ◽  
Traumatic Loss ◽  
Upper Eyelid ◽  
Thickness Loss

Background/Objective: Traumatic loss of the lower eye lid is usually combined with the paucity of adjacent flaps to reconstruct composite defects. We describe the use of Glabellar flaps with composite or cartilage graft to reconstruct total or near total composite lower eyelid defects and its outcome. Material and Methods: This case series was done from January 2017 to December 2019. Patients of either gender, with unilateral post traumatic partial or full thickness lower eyelid defect of 75% eyelid loss or more and Glabellar flap as only remaining option to reconstruct the anterior lamella were included. Patients with medial, lateral canthi, upper eyelid and injuries to orbital contents were excluded. The outcome was assessed on follow-up by the presence of epiphora, ectropion, lagophthalmos, obstruction of vision, graft infection/ extrusion, lower lid retraction, donor site scarring and the need for flap debulking. Results: 12 patients were operated for lower eyelid defects. 2 (16.7%) patients had total loss of eyelid, while 10 (83.3%) had near total loss, 7 (58.3%) patients presented with partial thickness loss of the eyelid, while rest presented with full thickness loss. 1 patient (8.3%) presented with epiphora, similarly 1 (8.3%) had obstruction of vision in down gaze and 1 (8.3%) had conjunctivitis. None had any other complaint. Conclusion: Glabellar flap together with composite or cartilage graft is an excellent option to reconstruct total or near total composite lower eyelid defects.

Management of Eyelid Retraction

2011 ◽  
Author(s):  
Alexander Taich ◽  
Adam S. Hassan
Keyword(s):  
Rectus Muscle ◽  
Lower Eyelid ◽  
Eyelid Retraction ◽  
Adrenergic Stimulation ◽  
Inferior Rectus ◽  
Blurred Vision ◽  
Eyelid Margin ◽  
Upper Eyelid ◽  
Inferior Rectus Muscle ◽  
Stimulation Of

Eyelid retraction has numerous causes. Most notably eyelid retraction is caused by thyroid eye disease (TED), trauma, and postsurgical changes. The upper eyelid margin is typically measured at 3.5 to 4.5 mm above the center of the cornea. The lower eyelid margin is typically situated at the inferior border of the limbus. Eyelid retraction is a condition in which the upper eyelid margin is displaced superiorly or the lower eyelid margin is displaced inferiorly. Eyelid retraction may result in exposure keratopathy and disturbing ocular symptoms, including blurred vision, photophobia, foreign body sensation, burning, and reactive tearing. Eyelid retraction in TED is thought to be due to a combination of inflammation, fibrosis, and adrenergic stimulation of the eyelid retractors. Proptosis can also contribute to eyelid retraction. In the upper eyelid, factors responsible for eyelid retraction include (1) inflammation and fibrosis of the levator and Müller’s muscles, (2) adrenergic stimulation of Müller’s muscle, and (3) inflammation and fibrosis of the inferior rectus muscle, causing hypodeviation of the globe and compensatory overaction of the superior rectus–levator complex. In the lower eyelid, factors responsible for eyelid retraction include (1) inflammation and fibrosis of the inferior rectus muscle with consequent traction on its anterior extension, the capsulopalpebral fascia, which is the main lower lid retractor, and (2) adrenergic stimulation of the smooth muscle fibers within the lower lid retractor complex. A combination of eyelid retraction and proptosis in TED may result in ocular exposure with symptoms of ocular irritation, an undesirable cosmetic appearance, corneal erosion and infection, or (rarely) globe luxation. Mild exposure problems can be managed with topical lubricants. Guanethidine, a topical sympatholytic agent, is of limited usefulness in the management of eyelid retraction due to its variable efficacy and frequent ocular side effects, including irritation, hyperemia, photophobia, pain, edema, burning sensation, and punctate keratitis. It may be more tolerable if used in lower concentrations. Exposure problems in the inflammatory phase of the condition present a special challenge as surgical correction of eyelid retraction is best performed in the pos-tinflammatory, stable phase. Several reports have described using Botulinum toxin injections, 2.5 to 15 U, either subconjunctivally or percutaneously, just above the superior border of the tarsus.

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