Defects in the eyelid can also arise from trauma or scarring from previous surgeries. Reprinted with permission from muzaffar ar, mendelson bc, adams wp jr. Various reconstructive procedures based on common principles, location and size of the. In addition, variations in periorbital structures provide for identifiable differences in ethnicity, gender, and age and display characteristic signs of various emotional states. The eyelid skin is the thinnest in the body and is often exposed to sunlight. One hundred consecutive caucasian patients were included in the study, 54 women and 46 men. Skin cancer is the most common problem requiring eyelid reconstruction. The width of the eye, the horizontal palpebral fissure. 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. The most difficult part of this surgery is to create a lid plate eyelid above the lashes from regular lid skin. Unfortunately, these skin cancers are relatively common if you have had a lot of exposure to the sun. In the past three years, ten patients have been reconstructed using a cheek flap over a chondromucosal graft, after extensive resection of lower. For reconstruction, as written by mustarde, when the eye. The fundamental principle for fullthickness eyelid reconstruction is based on reconstructing the subunits of the eyelid, including the.
Aesthetic total lower eyelid reconstruction springerlink. Various techniques are used to recreate volume and normal eye appearance. In all patients, the tumour was radically excised with a 3mm clear cutaneous margin and a 2mm tarsoconjunctival margin under frozen section control. The lower lid has a gentle s shaped curvature with the lowest point being just lateral to the pupil. Eyelid thin skin, areolar tissue, orbicularis occuli ms. Full thickness skin grafts in periocular reconstructions. 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. All asoprs members are boardcertified ophthalmologists who have completed advanced training in eyelid, orbit, tear duct system and facial cosmetic and reconstructive surgery.
Reconstructive eyelid surgery gallery philadelphia pa. Single tarsoconjunctival flap lower eyelid for upper. Zplasty to eliminate tension on the flap advanced medially. 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. Lower eyelid reconstruction after basal cell carcinoma. To report on a new onestep technique for the reconstruction of lower eyelid marginal defects. We use a system of vertical subunits to classify defects and guide reconstruction. It does not typically present any postoperative complications.
In this case, a rotational advancement cheek flap and composite graft were used to reconstruct the lower eyelid. Original article bilamellar lower eyelid reconstruction with. This study indicates significantly higher rates of. Eyelid reconstruction may be necessary for a variety of reasons besides tumors and their excision. 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. Reconstruction of the eyelids, correction of ptosis, and canthoplasty nicholas t. 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.
The tarsal plate is much larger in the upper eyelid than in the lower eyelid. 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. The upper and lower eyelid stay connected for 24 weeks. 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. Reconstruction of the lower eye lid with a rotation. Mucosa is provided by mobilizing the bulbar conjunctiva. Johns creek 770 6044141 northsidejohns creek medical office 3890 johns creek parkway, ste 240 suwanee, ga 30024. Lower eyelid defects are common, and a systematic approach to reconstruction of the lower eyelid is required.
Marlene morales, md rajat ghaiy, md kamel itani, md. Its margin just skirts the corneoscleral junction inferiorly. No one knows your eyes and face like an asoprs surgeon. This article describes the reconstruction of the lower eyelid in two layers. 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. Reconstruction of periocular defects following excision of cutaneous malignancy can present difficulties for oculofacial and reconstructive surgeons. With lower eyelid corrections lower blepharoplasty the skin and muscle is tightened and fat bulges corrected by either removal or repositioning or a. It is associated with sun damage and is the least aggressive skin cancer. A number of procedures have been described for upper eyelid reconstruction. Columbia, missouri when more than 25% of an eyelid is missing.
Ahmad takes part of the upper eyelid tarsal plate and moves it into the lower eyelid to reform the lower eyelid margin. 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. Various techniques have been described in the literature for eyelid reconstruction. What are common problems that need eyelid reconstruction.
Pdf reconstruction of the eyelids after mohs surgery. Haddock the eyelids provide globe protection and preserve vision. 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. In 2448 hours, the eyepad is removed and the patient can use the eye. We read with great interest the article by alghoul and colleagues entitled lower eyelid reconstruction. Learn vocabulary, terms, and more with flashcards, games, and other study tools. 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. The anterior lamella was reconstructed with orbicularis muscle advancement and a. Eyelid cancer excision and reconstruction may be necessary if you have developed a skin cancer on your eyelids. Reconstruction of the lower eyelid with a rotationadvancement tarsoconjunctival cheek flap. Three cases of single stage, bilamellar reconstruction of fullthickness, horizontal, lateral three quarter lower eyelid defects using pedicled island flaps of.
The intricate anatomy of the eyelids and face requires precise restoration in order to avoid postoperative functional anesthetic concerns. Total upper eyelid reconstruction with mucosalized tarsal. Reconstruction of the lower eyelid seeks to restore both anatomic function and prereconstructive lid aesthetics. When performing eyelid reconstruction, it is important to successfully recreate the eyelid crease for a better cosmetic result. 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. To describe the use of the temporoparietal fascial flap tpf in the reconstruction of extensive lower eyelid defects in a functioning eye. Pdf to text batch convert multiple files software please purchase personal license. Basic principles of eyelid burn scar release involve a thorough, wide, and overcorrecting release of the deformity. Indications for full thickness skin grafts were excision of. A graft is necessary to reconstruct the posterior lamella. 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. Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus. Pdf reconstruction of eyelids defects researchgate.
The lower eyelid was resected, and a composite nasal cartilagemucosa graft, a skin graft, and a tpf were used to reconstruct the. The goals of eyelid reconstruction include structural and functional restoration with an acceptable aesthetic result. Reconstructions of eyelid defects of the cornea in children and 11. 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. 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. Attention to the bilaminar eyelid anatomy and canthal support structures, with efforts. Modified tripier flap in reconstruction of the lower eyelid. Classification of lower eyelid defects has previously focused on the missing horizontal percentage of the lid. Right lower eyelid reconstruction after skin cancer removal.
Retrospective case series of 5 patients with lower eyelid basal cell carcinomas abutting the eyelid margin. Holds and his team at ophthalmic plastic and cosmetic surgery, inc. Principles of periocular reconstruction following excision. 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.
Pdf as the lower eyelid is frequently the site of malignant disease, lower lid replacement is a common task in oculoplastic surgery. When repairing lower eyelid defects, one must ensure proper eyelid closure while avoiding the complications of eyelid notching, entropion and ectropion. Eyelid reconstruction skin cancer and reconstructive. 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. This depends on the type of skin cancer and technique used to remove it. Reconstruction of the total lower eyelid defect useful. Eyelid reconstruction austin oculofacial san antonio.
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. Small defects can be directly sutured closed, even if they extend through the full thickness of the eyelid. We apply a wide variety of the most uptodate surgical techniques to make this possible. A technique for the reconstruction of lower eyelid. Reconstruction of the lower eyelid by lateral advancement using a. In most dogs, the skin graft is successful, and the appearance of the eyelid is normal after six weeks. 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. The anterior lamella was reconstructed with orbicularis muscle advancement and a free skin graft from the ipsilateral upper eyelid. The tarsal plate is no longer taken into consideration. Trust your eyes and face to a surgeon who specializes in oculofacial plastic surgery. How long after the removal of skin cancer on the lower eyelid will i have to wait for any reconstruction surgery.
The aim of eyelid cancer reconstruction is to reconstruct the eyelid after ensuring the cancerous tissue has been excised. After photos were taken 3 months after surgeryprocedure. A sound understanding of the nature of lower eyelid anatomy and function is. Eyelid reconstruction an oculoplastic surgical coding. Reconstruction of the eyelids, correction of ptosis, and. Purposeto explore the clinical effect of the pedicled lower lidsharing flap for fullthickness reconstruction of the upper eyelid.
The advantages of this technique for large or total upper eyelid reconstruction include the following. Eyelid reconstruction is a challenging procedure demanding technical skill and expertise. Unfortunately sun damage, combined with genetics, can lead to skin cancers of the eyelids, including at the lid margin. The vast majority of eyelid cancers are basal cell carcinomas 90%, followed far behind by squamous cell carcinoma 5%, and melanoma 12%. Tumor excision and trauma are 2 common causes of eyelid defects requiring surgical reconstruction. Reconstruction of fullthickness lower eyelid defects. Lower eyelid reconstruction following a traumatic full thickness loss. 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. Lower eyelid reconstruction following a traumatic full. Lower eyelid reconstruction ophthalmology coding ask.
A new classification incorporating the vertical dimension plast reconstr surg. Lower eyelid reconstruction by tarsal transposition. It is slow growing and does not spread to the rest of the body. In full thickness lower eyelid injuries, it will involve both anterior and posterior lamella. Eyelid reconstruction, though invasive, is often effective for treating eyelid conditions. To report our experience on lid reconstruction in patients with epitheliomas. Reconstruction of fullthickness lower eyelid defects l. Eyelid tumor excision and trauma are 2 common causes of eyelid defects requiring surgical reconstruction. We present a surgical case report of a 73yearold female with melanoma of the left lower eyelid. As a result, it is often one of the first areas to show sign of aging and sun damage. 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. Reconstruction of total lower eyelid defects with the.