Combined Hard Palate Spacer Graft, Midface Suspension, and Lateral Canthoplasty for Lower Eyelid Retraction: A Tripartite Approach

Patel, Munjal P.; Shapiro, Michael D.; Spinelli, Henry M.

doi:10.1097/01.prs.0000164677.25488.49

Cited by 66 publications

(65 citation statements)

References 31 publications

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“…A mean reduction in lagophthalmos, superficial punctate keratopathy, and scleral show was demonstrated for all etiology groups and graft types included in the study. 74 Similarly, Patel et al 23 retrospectively reviewed the outcomes of 17 patients who underwent hard palate spacer grafting, lateral canthal suspension, and midface elevation for repair of lower eyelid retraction. All 17 patients had complete resolution of scleral show and preoperative dry eye symptoms.…”

Section: Discussionmentioning

confidence: 98%

“…3 Hard palate mucosa has become one of the most commonly used posterior lamella spacer grafts. 1,3,4,22,23,[46][47][48][49] The hard palate is formed by the palatine processes of the maxilla and the horizontal processes of the palatine bones with the overlying soft tissue. 72 It forms the roof of the oral cavity and the floor of the nasal cavity.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the use of synthetic materials including polytetrafluoroethylene 29,30 and porous polyethylene 31-34 has also been described. Autogenous and irradiated tarsus, [35][36][37][38] donor sclera, 39,40 dermis grafts, 41 auricular cartilage, 20,42-45 cadaveric dermal collagen, 1 and hard palate mucosal grafts 1,3,4,22,23,[46][47][48][49][50] have also been used with varying success rates. The auricular cartilage and hard palate mucosal grafts have probably enjoyed the most use.…”

mentioning

confidence: 99%

“…17,18 Full-thickness skin grafts have also been used to lengthen the anterior lamella vertically with and without posterior spacer grafts, most commonly following lower eyelid transcutaneous blepharoplasty. 19,20 Likewise, preperiosteal and subperiosteal midface lifts have been used to recruit more anterior lamella [21][22][23][24][25] and primary retractor release. 7,26 Although these methods have been successful in a variety of eyelid retraction situations, severe retraction of the posterior lamella requires the use of a posterior lamella spacer graft to achieve the highest rate of success.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Porcine Dermal Collagen in Lower Eyelid Retraction Repair

Dailey

Marx

Ahn

2015

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Porcine Dermal Collagen in Lower Eyelid Retraction Repair

Dailey

Marx

Ahn

2015

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…Patel et al [29] used a tripartite approach (HPG, lateral canthal suspension, and midface elevation) in patients with lower lid retraction (including 5 patients with paralytic aetiology), and Graziani et al [30] used subperiosteal midface lifting with Endotine midface ST implants anchored to the temporal fascia without any type of graft, both with satisfactory functional and cosmetic results.…”

Section: Surgical Therapymentioning

confidence: 99%

Lagophthalmos after Facial Palsy: Current Therapeutic Options

Vásquez

Medel²

2014

Ophthalmic Res

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As the facial nerve carries sensory, motor and parasympathetic fibres involved in facial muscle innervation, facial palsy results in functional and cosmetic impairment. It can result from a wide variety of causes like infectious processes, trauma, neoplasms, autoimmune diseases, and most commonly Bell's palsy, but it can also be of iatrogenic origin. The main ophthalmic sequel is lagophthalmos. The increased surface exposure increases the risk of keratitis, corneal ulceration, and potentially loss of vision. Treatment options are wide; some are temporary, some permanent. In addition to gold standard and traditional therapies and procedures, new options are being proposed aiming to improve not only lagophthalmos but also the quality of life of these patients.

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The Minimally Invasive, Orbicularis-Sparing, Lower Eyelid Recession for Mild to Moderate Lower Eyelid Retraction With Reduced Orbicularis Strength

Yoo

Griffin

Azizzadeh

2014

JAMA Facial Plast Surg

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to address lower eyelid retraction (LER) in the presence of an orbicularis deficit is a useful tool for aesthetic and reconstructive eyelid surgery. OBJECTIVE To describe and evaluate a surgical technique consisting of a closed canthal suspension and true lower eyelid retractor recession to address LER in the setting of orbicularis weakness. DESIGN, SETTING, AND PARTICIPANTS A retrospective medical record review of patients who underwent the minimally invasive, orbicularis-sparing, lower eyelid recession from January 1, 2010, to October 1, 2012, by one of us (G.G.M.) in an ophthalmic plastic surgical practice. We included 29 patients with reduced orbicularis strength and LER resulting from eyelid paresis related to facial nerve disease, surgical trauma (after blepharoplasty), involutional change, or idiopathic causes. INTERVENTIONS Surgical intervention consisting of closed canthal suspension and lower eyelid retractor recession. MAIN OUTCOMES AND MEASURES Surgical results, complications, and patient satisfaction. RESULTS The 29 patients included 18 women and 11 men. The mean patient age was 52 (range, 6-72) years; mean follow-up, 11 (range, 6-21) months; and mean preoperative orbicularis strength, 2.7 (on a scale of 0-4, where 0 indicates no function and 4, normal function). The causes of orbicularis weakness included eyelid paresis related to facial nerve disease (11 patients), surgical trauma (13 patients), involutional change (4 patients), and an isolated idiopathic finding (1 patient). In 12 patients, the eyelid retraction was unilateral; in 17, bilateral. A small tarsorrhaphy was added to the surgery in 6 patients with facial nerve disease. The mean eyelid elevation after surgery was 1.80 mm, with only minor complications. Patient and surgeon satisfaction were high. CONCLUSIONS AND RELEVANCE Recent publications have demonstrated the utility of closed canthal suspension and true lower eyelid retractor recession as separate procedures. In the setting of LER with reduced orbicularis strength and/or tone, the techniques can be combined to recess the lower eyelid without disturbing the already compromised lower orbicularis muscle (minimally invasive, orbicularis-sparing, lower eyelid recession). The combination technique is safe and effective and yields excellent results. LEVEL OF EVIDENCE 4

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Combined Hard Palate Spacer Graft, Midface Suspension, and Lateral Canthoplasty for Lower Eyelid Retraction: A Tripartite Approach

Cited by 66 publications

References 31 publications

Porcine Dermal Collagen in Lower Eyelid Retraction Repair

Porcine Dermal Collagen in Lower Eyelid Retraction Repair

Lagophthalmos after Facial Palsy: Current Therapeutic Options

The Minimally Invasive, Orbicularis-Sparing, Lower Eyelid Recession for Mild to Moderate Lower Eyelid Retraction With Reduced Orbicularis Strength

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