Periocular Mohs Reconstruction by Lateral Canthotomy With Inferior Cantholysis: A Retrospective Study

Abstract

BACKGROUND Most eyelid defects after Mohs micrographic surgery are referred to oculoplastic surgery or plastic surgery for reconstruction, but growing evidence suggests the safety of such repairs performed by dermatologic surgeons is equivalent if not better. Lateral canthotomy with inferior cantholysis may be used by the dermatologic surgeon to reconstruct larger lower eyelid defects. OBJECTIVE To demonstrate lateral canthotomy with inferior cantholysis performed by the dermatologic surgeon can result in safe, functionally and cosmetically acceptable surgical outcomes. MATERIALS AND METHODS An institutional review board-approved retrospective study of repairs performed by a single dermatologic surgeon between January 2013 and August 2019. Patient demographics, operative and follow-up notes were reviewed. Two cosmetic dermatologists assessed aesthetic results based on final follow-up photographs using a visual analogue scale. RESULTS Eight cases were included in the analysis. Seventy-five percent of patients were men, with a mean age of 74.1 years old. All tumors were basal cell carcinoma; the mean defect size was 2.4 cm2. No serious complications or postoperative interventions occurred. The median cosmetic score was 85.6 ± 11.5. CONCLUSION Dermatologic surgeons can safely perform repairs of lower eyelid defects with lateral canthotomy with inferior cantholysis, achieving satisfactory functional and cosmetic outcomes.

The Lateral Orbital Thickening and the Lateral Brow Thickening: A New Choice for the Lower Eyelid Suspension

“…The additional release methods were usually applied to the infraorbital rim to assist lower eyelid defect reconstruction, such as lateral canthotomy and cantholysis. Because the ORL main trunk attaches to the infraorbital rim, the appropriate release could free the remnant tissue of the lower eyelid 24. Based on the current research of the ORL, we believed that the release of the infraorbital ligament could decrease downward traction to defects.…”

“…Because the ORL main trunk attaches to the infraorbital rim, the appropriate release could free the remnant tissue of the lower eyelid. 24 Based on the current research of the ORL, we believed that the release of the infraorbital ligament could decrease downward traction to defects. However, it is far away from enough for maintaining the power balance of the reconstructed lower eyelid.…”

Complex Eyelid Reconstruction: A Practical Guide for the Mohs Surgeon

“…If there is inadequate lid laxity for primary closure, lateral canthotomy with inferior cantholysis can provide additional advancement to allow for direct primary closure for most lower and upper lid defects. 27 This technique, as previously detailed, 28 starts with an incision originating at the lateral canthus that is an extension of the lateral contour of the eyelid. The incision is made to the level of the suborbicularis oculi fat.…”

Periosteal flaps allow for single stage reconstruction of larger full thickness eyelid defects: a retrospective study

“…Defects of the posterior lamella that involve 50-100% of the eyelid margin have traditionally required lid-sharing procedures such as the Cutler-Beard ap (upper lid) and the Hughes tarsoconjunctival ap (lower lid). 11 These interpolation aps require the patient to tolerate monocular vision for up to three weeks prior to pedicle division. Such visual de cits for extended periods of time are universally di cult for patients and even dangerous and/or disabling in certain patient populations.…”