Mucous Membrane Grafting

Abstract

The reformation and maintenance of a conjunctival fornix requires the addition of epithelial tissue, or a basement membrane which can be populated by healthy host epithelial cells. A healthy conjunctival or tarsal autograft, when available, is the ideal material. Oral mucosa does not contain goblet cells and therefore does not supplement the tear film: a full-thickness oral mucous membrane graft is the simplest graft to use if conjunctiva or tarsus is not available. Split-thickness mucosal grafts contract more, but are less bulky and pink than full-thickness grafts, and therefore should be used on the globe. Hard palate grafts are the thickest oral mucosal grafts and contract the least. Nasal mucosal grafts contain goblet cells that may contribute mucous to the tear film. This is maximised in turbinate mucosal grafts, which can relieve discomfort in extreme dry eye situations. Nasal septal cartilage contains fewer goblet cells, but adds rigidity. Amniotic membrane is thin and translucent-like conjunctiva, and possesses antiangiogenic, antiscarring and anti-inflammatory properties. It may become re-epithelialised with normal a conjunctival cell population and prevent postoperative cicatrisation, but requires the presence of healthy conjunctival stem cells to repopulate the graft, adequate lacrimal function to keep the graft moist, and a host site that is free from inflammation, otherwise it rapidly contracts. It can be combined with limbal transplantation and with an adjunctive antimetabolite.

Oral Mucosal Grafts in Severe Pterygium: Case Report

“…21 Sert damak greftleri ise; müköz membran greftleri arasında en kalın ve kontraksiyonun en az görüldüğü grubu oluştur-maktadır. 22 Tam kat yanak mukoza greftleri primer ve rekürrens piterjium tedavisinde kullanılabil-mektedir. Nüks oranlarının oldukça düşük olduğu bildirilmiştir.…”

Oral Mucosal Grafts: Old Technique in New Light

“…Nasal septal cartilage contains fewer goblet cells but is useful in the reconstruction of the posterior lamella when the tarsus is lacking; the graft replaces the rigidity of the tarsus, and its attached mucoperichondrium provides a mucosal binding which does not shrink and can be wrapped around the skin of the reconstructed eyelid to form a stable eyelid margin [1] (table 1). In recent years, a combination of different tissue types has been introduced, such as amnion membrane and oral mucosa transplants, in the same eye [4,5].…”

“…A broad variety of techniques, materials and grafts have been used to replace ocular surface tissue [1]. In cases when a conjunctival wound cannot be adapted, secondary healing of the conjunctiva leads to more or less irritating and dysfunctional conjunctival scarring.…”

“…Mucous membrane transplants have been used for over a century in the reconstruction of fornices obliterated by symblepharon formation [1]. The assessment of this technique has changed over time.…”

Dry eye diagnosis and management

“…Corneal epithelial defects and ulcerations can be covered by amniotic or mucous membrane transplantation (FigurE 4) [99,100]. Partial or total tarsorrhaphy is useful in patients with delayed epithelial wound healing and who are refractory to the aforementioned treatments [101].…”