Total or subtotal replacement of tarsal plate by novel silicone plate for upper eyelid reconstruction in malignant tumors

Abstract

Purpose: To evaluate the cost, safety, surgical outcome, and efficacy of modified Cutler–Beard eyelid reconstruction utilizing a novel silicone plate as a tarsal plate replacement in the repair of 60% to 100% eyelid defects following the excision of large malignant tumors. Methods: A prospective, noncomparative, interventional study of 30 eyes was done over 3 years. Fourteen patients were female, and 16 patients were male. In all the cases, a silicone plate, the synthetic, artificial tarsal plate, was utilized for a total or subtotal replacement of the tarsal plate. The created defect was measured in mm (length and width) and later expressed in percentage. Pre- and postoperative action of levator palpebrae superioris (LPS) was measured. Pre- and postoperative measurements of the margin-to-margin reflex distance (MRD1) were noted. Results: Preoperative LPS action was 1.23 ± 1.35 mm, whereas postoperative LPS actions at the end of 1 week and 18 months were 11. 8 ± 0.88 mm and 13.53 ± 0. 73 mm, respectively. Preoperative MRD1 was − 3.0 ± 1.144 mm, whereas postoperative MRD1 values at the end of 1 week and 18 months were 2.18 ± 0.27 mm and 4.16 mm ± 0.35, respectively. The mean created defect after the removal of the tumor was 87.3% ±11.10. The mean length of the silicone plate implanted in this study was 27.53 ± 2.48 mm. The follow-up period for the study participants was 18 months. Conclusion: The synthetic novel silicone plate was successful as a tarsal plate replacement. A second surgical site for ear cartilage harvesting is avoided. Cadaver transfer of Achilles tendon carries the risk of transmission of communicable diseases, for example, hepatitis B and HIV. Silicone is an inert, nonreacting, and tissue-tested material, thus eliminating the possibility of graft rejection. This material is readily available and cost-effective. The novel silicone plate is considered to be the most promising alternative material as a tarsal replacement in the future generation.

A comparison of novel silicone plate vs. auricular cartilage in upper eyelid reconstruction following excision of malignant tumor

“…In this study, the post-operative MRD-1 and LPS action values in the silicone plate group was better than in the group using ear cartilage in the 1st week and 1st month post-operative follow-up, which was statistically significant, but at the 6th month follow-up, the difference in values in the two groups was not statistically insignificant. The mean post-operative MRD 1, LPS action values obtained for both groups at one week, one month and six months post-operative period were similar to those obtained by Mandal SK et al in 2016 and 2021 [ 10 , 11 ].…”

“…Hence, the search for ideal tarsal plate substitute continued. In a very recent study, again by Mandal SK et al (2021), a novel tarsal plate substitute in the form of a silicone plate was proposed and the cosmetic and functional outcome was studied [ 11 ]. The elliptical design of a silicone plate was custom made to resemble the tarsal plate in its dimensions.…”

“…These drawbacks with the use of allogenic or autogenous grafts have been overcome with the use of a novel synthetic silicone plate. The cost of the novel silicone plate is around 483 INR (6.5$) [ 11 ]. The silicone plate is cost effective, and this has enabled its use in socioeconomically weaker populations.…”

“…Despite the excellent post-operative tissue acceptance and tissue adaptability, the newly created upper lid was thicker and not cosmetically satisfactory. In 2021, Mandal SK et al used a silicone plate fashioned from a commercially available scleral buckle as tarsal substitute [ 11 ]. This silicone plate was found to overcome all the disadvantages encountered with the tarsal substitutes previously used.…”