Application of Kuhnt–Szymanowski Procedure to Lower Eyelid Margin Defect after Tumor Resection

Abstract

Background:Lower eyelid reconstruction after tumor removal is always challenging, and full-thickness defects beyond half of the eyelid length require a flap from a part other than the remaining lower eyelid, such as the temporal area or the cheek.Objective:We aimed to report our experience of applying Smith-modified Kuhnt–Szymanowski, one of the most popular procedures for paralytic ectropion, for reconstructing oblong full-thickness lower eyelid margin defect.Materials and Methods:We performed Smith-modified Kuhnt–Szymanowski on 5 cases of oblong full-thickness lower eyelid margin defect after skin cancer removal. The mean age of patients was 80.0 years. The horizontal widths of the defects ranged from half to two-thirds of the lower eyelid length and the vertical width ranged from 5 to 9 mm.Results:We obtained good functional and esthetic results in all cases. No patients developed ectropion or lower eyelid distortion, and all patients were satisfied with their results.Conclusions:We utilized the procedure for morphological revision as a reconstructive procedure for eyelid margin defect by considering the defect as a morphological deformity of the eyelid margin; thus, donor tissue was not required to fill the defect and we could accomplish the reconstruction simply, firmly, and less invasively.

Treatment for ophthalmic paralysis: functional and aesthetic optimization

“…The Smith-modified Kuhnt–Szymanowski (SMKS) procedure is one of the most popular procedures to manage such presentations [ 23 ]. Consideration of the anthropometric complexity of the eyelid is essential [ 24 ]. The SMKS procedure begins with a subciliary incision beyond the lateral canthus, medial to the defect excised with a wedge shape; a posterior lamellar defect can be covered with a free chondromucosal graft from the nasal septum and a skin flap elevated superolaterally.…”

Posterior lamella substitutes in full-thickness eyelid reconstruction: a narrative review

“…The nasal chondromucosal graft has been reported to reconstruct the posterior lamella of eyelids due to mucosal covering, good eyelid stability, and esthetic outcome in the late postoperative period (42,(51)(52)(53)(54)(55). Keçeci et al (51) used a septal chondromucosal graft with a nasojugal angular artery-based axial flap to repair full-thickness eyelid defects in eight patients.…”

Case report: Lower eyelid Reconstruction with the rotation flap pedicled by orbicularis oculi muscle

“…Tumor excision accounts for a considerable proportion of eyelid reconstructions. Twenty-five percent of eyelid tumors are malignant ( 2 ), and up to 14% eyelid tumors attributes to basal cell carcinomas emanated from the periorbital area, of which 90% were involved the eyelids ( 3 ). Squamous cell carcinoma is uncommon, but is often found on the lower eyelid and aggressive ( 4 ).…”