The most difficult part of this surgery is to create a lid plate eyelid above the lashes from regular lid skin. A technique for the reconstruction of lower eyelid. Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus. Eyelid reconstruction an oculoplastic surgical coding. Reconstruction of the lower eye lid with a rotation. Attention to the bilaminar eyelid anatomy and canthal support structures, with efforts.
When repairing lower eyelid defects, one must ensure proper eyelid closure while avoiding the complications of eyelid notching, entropion and ectropion. It does not typically present any postoperative complications. Modified tripier flap in reconstruction of the lower eyelid 109 discussion tripier flap is considered a myocutaneous, bipedicular flap, originating from the upper eyelid and recommended for the reconstruction of defects located in the lower eyelid. Unfortunately sun damage, combined with genetics, can lead to skin cancers of the eyelids, including at the lid margin. A sound understanding of the nature of lower eyelid anatomy and function is. To describe the use of the temporoparietal fascial flap tpf in the reconstruction of extensive lower eyelid defects in a functioning eye. For reconstruction, as written by mustarde, when the eye. Reconstruction of the lower eyelid with a rotationadvancement tarsoconjunctival cheek flap. How long after the removal of skin cancer on the lower eyelid will i have to wait for any reconstruction surgery.
Holds and his team at ophthalmic plastic and cosmetic surgery, inc. Therefore, combining a nonvascularized graft for one lamella with a vascularized flap for the other should be the rule. Reconstruction of fullthickness lower eyelid defects. The best posterior lamellar graft is the patients own tarsoconjunctiva, which can be harvested from the upper eyelid or the contralateral eyelid to fill the lower eyelid defect.
Small defects can be directly sutured closed, even if they extend through the full thickness of the eyelid. The width of the eye, the horizontal palpebral fissure. To report our experience on lid reconstruction in patients with epitheliomas. We apply a wide variety of the most uptodate surgical techniques to make this possible. In full thickness lower eyelid injuries, it will involve both anterior and posterior lamella. The advantages of this technique for large or total upper eyelid reconstruction include the following. We read with great interest the article by alghoul and colleagues entitled lower eyelid reconstruction. A graft is necessary to reconstruct the posterior lamella. The intricate anatomy of the eyelids and face requires precise restoration in order to avoid postoperative functional anesthetic concerns. The fundamental principle for fullthickness eyelid reconstruction is based on reconstructing the subunits of the eyelid, including the. Single tarsoconjunctival flap lower eyelid for upper. Reconstruction of the total lower eyelid defect useful. Ahmad takes part of the upper eyelid tarsal plate and moves it into the lower eyelid to reform the lower eyelid margin. Other surgeries of the eye include the eyelid lift to remove excess skin and wrinkles, tear duct surgery to treat blockages of the tear drainage ducts, and droopy eyelid repair to correct eyelid obstruction.
Columbia, missouri when more than 25% of an eyelid is missing. If the tumor is basal cell carcinoma or squamous cell carcinoma and the mohs technique is used, then reconstruction would likely be performed at the same. Reconstruction of total lower eyelid defects with the. The upper and lower eyelid stay connected for 24 weeks. The occidental upper eyelid crease is 8 to 9 mm superior to the eyelid margin centrally in men and 8 to 11 mm superior to the margin in women. Eyelid reconstruction, though invasive, is often effective for treating eyelid conditions.
After photos were taken 3 months after surgeryprocedure. All asoprs members are boardcertified ophthalmologists who have completed advanced training in eyelid, orbit, tear duct system and facial cosmetic and reconstructive surgery. Reconstruction of fullthickness lower eyelid defects l. No one knows your eyes and face like an asoprs surgeon. 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. Learn vocabulary, terms, and more with flashcards, games, and other study tools. During the past two centuries, hundreds of surgical procedures have been described for the purpose of eyelid reconstruction, perhaps because of the great value attached to the eyes and vision by our culture. Lower eyelid reconstruction ophthalmology coding ask. The lower eyelid was resected, and a composite nasal cartilagemucosa graft, a skin graft, and a tpf were used to reconstruct the. Its margin just skirts the corneoscleral junction inferiorly.
Eyelid reconstruction is a challenging procedure demanding technical skill and expertise. Knowledge of surgical eyelid anatomy and appropriate preoperative planning are critical in order to perform eyelid reconstruction and minimize complications and the need for reoperation. Lower eyelid reconstruction following a traumatic full thickness loss. Zplasty to eliminate tension on the flap advanced medially. It is slow growing and does not spread to the rest of the body. The aim of eyelid cancer reconstruction is to reconstruct the eyelid after ensuring the cancerous tissue has been excised. Lower eyelid reconstruction after basal cell carcinoma. Lower eyelid reconstruction following a traumatic full. Retrospective case series of 5 patients with lower eyelid basal cell carcinomas abutting the eyelid margin. Eyelid cancer surgery eyelid reconstruction after cancer removal mohs eyelid reconstruction see the gallery about five to ten percent of all skin cancers occur on the eyelids. Various techniques are used to recreate volume and normal eye appearance. A new classification incorporating the vertical dimension plast reconstr surg.
Lower eyelid reconstruction by tarsal transposition. Eyelid bags and wrinkles at rest result from a combination of skin and muscle laxity andor excess, and fat excess or weakness of the supporting tissues allowing the fat to bulge outwards. Modified tripier flap in reconstruction of the lower eyelid. In all patients, the tumour was radically excised with a 3mm clear cutaneous margin and a 2mm tarsoconjunctival margin under frozen section control. Pdf reconstruction of eyelids defects researchgate. Reconstruction of periocular defects following excision of cutaneous malignancy can present difficulties for oculofacial and reconstructive surgeons.
As a result, it is often one of the first areas to show sign of aging and sun damage. This article describes the reconstruction of the lower eyelid in two layers. Eyelid reconstruction austin oculofacial san antonio. Various reconstructive procedures based on common principles, location and size of the. This depends on the type of skin cancer and technique used to remove it. Mucosa is provided by mobilizing the bulbar conjunctiva. Unfortunately, these skin cancers are relatively common if you have had a lot of exposure to the sun. Right lower eyelid reconstruction after skin cancer removal. Pdf reconstruction of the eyelids after mohs surgery. Abstract the repair of fullthickness defects of the lower eyelids poses a challenge because a graft in combination with a flap is typically used to replace either the posterior or anterior lamella. Original article bilamellar lower eyelid reconstruction with. Purposeto explore the clinical effect of the pedicled lower lidsharing flap for fullthickness reconstruction of the upper eyelid. Marlene morales, md rajat ghaiy, md kamel itani, md. Classification of lower eyelid defects has previously focused on the missing horizontal percentage of the lid.
The tarsal plate is no longer taken into consideration. Eyelid reconstruction may be necessary for a variety of reasons besides tumors and their excision. With lower eyelid corrections lower blepharoplasty the skin and muscle is tightened and fat bulges corrected by either removal or repositioning or a. Reconstructions of eyelid defects of the cornea in children and 11. The eyelid skin is the thinnest in the body and is often exposed to sunlight. In most dogs, the skin graft is successful, and the appearance of the eyelid is normal after six weeks. Reconstruction of the lower eyelid by lateral advancement using a. Eyelid cancer excision and reconstruction may be necessary if you have developed a skin cancer on your eyelids. Eyelid reconstruction home eyelid reconstruction all images on this website are the copyrighted property of their respective owners and may not be used without express permission from skin cancer and reconstructive surgery center. Total upper eyelid reconstruction with mucosalized tarsal. Haddock the eyelids provide globe protection and preserve vision. Pdf to text batch convert multiple files software please purchase personal license. In this case, a rotational advancement cheek flap and composite graft were used to reconstruct the lower eyelid.
A number of procedures have been described for upper eyelid reconstruction. 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. Our skin is constantly exposed to sun, which is one of the risks for skin cancers such as basal cell carcinoma and squamous cell carcinoma. This study indicates significantly higher rates of. Eyelid thin skin, areolar tissue, orbicularis occuli ms. Reconstruction of the eyelids, correction of ptosis, and canthoplasty nicholas t. Reconstruction of the eyelids, correction of ptosis, and.
Indications for full thickness skin grafts were excision of. In 2448 hours, the eyepad is removed and the patient can use the eye. Eyelid reconstruction from one of our experienced doctors at gordon schanzlin new vision institute institute may be necessary due to benign tumors, trauma, or skin cancer affecting the lids. Various techniques have been described in the literature for eyelid reconstruction. Three cases of single stage, bilamellar reconstruction of fullthickness, horizontal, lateral three quarter lower eyelid defects using pedicled island flaps of. To report on a new onestep technique for the reconstruction of lower eyelid marginal defects. Various techniques have been used for reconstruction of extensive lower eyelid defects, but it is difficult to achieve results which are satisfactory, both from a functional and cosmetic viewpoint. Volume 2, number 2 eyelid reconstruction 291e grafts in eyelid reconstruction as a basic principle in plastic surgery, grafts should be used when there is an adequate vas cular bed to enhance their survival. Pdf as the lower eyelid is frequently the site of malignant disease, lower lid replacement is a common task in oculoplastic surgery. The goals of eyelid reconstruction include structural and functional restoration with an acceptable aesthetic result. Reprinted with permission from muzaffar ar, mendelson bc, adams wp jr.
The anterior lamella was reconstructed with orbicularis muscle advancement and a free skin graft from the ipsilateral upper eyelid. The lower lid has a gentle s shaped curvature with the lowest point being just lateral to the pupil. Skin cancer is the most common problem requiring eyelid reconstruction. Structural restoration of the anterior lamella provides skin coverage and blood supply to the eyelid while that of the posterior lamella provides semirigid support to the eyelid and a nonabrasive mucosal surface for normal blinking, which helps keep the ocular surface moist. Defects in the eyelid can also arise from trauma or scarring from previous surgeries. In the past three years, ten patients have been reconstructed using a cheek flap over a chondromucosal graft, after extensive resection of lower. 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. The vast majority of eyelid cancers are basal cell carcinomas 90%, followed far behind by squamous cell carcinoma 5%, and melanoma 12%. Lids can be reconstructed by local flaps or by harvesting tissue from other parts of the face and body. Trust your eyes and face to a surgeon who specializes in oculofacial plastic surgery. We present a surgical case report of a 73yearold female with melanoma of the left lower eyelid.
Basic principles of eyelid burn scar release involve a thorough, wide, and overcorrecting release of the deformity. What are common problems that need eyelid reconstruction. We use a system of vertical subunits to classify defects and guide reconstruction. Principles of periocular reconstruction following excision. Aesthetic total lower eyelid reconstruction springerlink. Johns creek 770 6044141 northsidejohns creek medical office 3890 johns creek parkway, ste 240 suwanee, ga 30024. The tarsal plate is much larger in the upper eyelid than in the lower eyelid. It is associated with sun damage and is the least aggressive skin cancer. One hundred consecutive caucasian patients were included in the study, 54 women and 46 men. Eyelid tumor excision and trauma are 2 common causes of eyelid defects requiring surgical reconstruction. The anterior lamella was reconstructed with orbicularis muscle advancement and a. In the unfortunate event of trauma or eyelid cancer, eyelid reconstruction may be necessary to improve eyelid function and preserve vision while maintaining an aesthetically natural appearance. Tumor excision and trauma are 2 common causes of eyelid defects requiring surgical reconstruction. In addition, variations in periorbital structures provide for identifiable differences in ethnicity, gender, and age and display characteristic signs of various emotional states.
Lower eyelid defects are common, and a systematic approach to reconstruction of the lower eyelid is required. Reconstruction of the lower eyelid seeks to restore both anatomic function and prereconstructive lid aesthetics. Lower eyelid reconstruction following a traumatic full thickness loss med j malaysia vol 72 no 3 june 2017 201 be larger than the cartilage so that it may form the eyelid margin and conjunctiva. Eyelid reconstruction skin cancer and reconstructive. Reconstructive eyelid surgery gallery philadelphia pa.