Lower Eyelid Reconstruction Workup

  • Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS; Chief Editor: Lars M Vistnes, MD, FRCSC, FACS   more...
 
Updated: Nov 13, 2011
 

Imaging Studies

For significant trauma or large invasive tumors, consider imaging studies to exclude involvement of adjacent structures, orbit soft tissue, orbital bones, nose, sinuses, and zygoma.

  • CT scan of orbits and sinuses is the best imaging modality when looking at bony involvement.
  • MRI is the best imaging modality when looking at soft tissue involvement.
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Other Tests

Lacrimal system exploration: Irrigation and possibly intubation may be necessary for protection or repair of the lacrimal drainage system, especially in medial trauma cases.

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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS  Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Neal R Reisman, MD, JD  Chief of Plastic Surgery, St Luke's Episcopal Hospital; Clinical Professor of Plastic Surgery, Baylor College of Medicine

Neal R Reisman, MD, JD is a member of the following medical societies: American Association of Plastic Surgeons, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, Lipoplasty Society of North America, Texas Medical Association, and Texas Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jorge I de la Torre, MD, FACS  Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Lars M Vistnes, MD, FRCSC, FACS  Professor of Surgery, Emeritus, Stanford University Medical Center

Lars M Vistnes, MD, FRCSC, FACS is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References

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  2. Mathijssen IM, van der Meulen JC. Guidelines for reconstruction of the eyelids and canthal regions. J Plast Reconstr Aesthet Surg. Jun 24 2009;[Medline].

  3. Erdogmus S, Govsa F. The arterial anatomy of the eyelid: importance for reconstructive and aesthetic surgery. J Plast Reconstr Aesthet Surg. 2007;60(3):241-5. [Medline].

  4. Ambrozová J, Mesták J, Smutková J. Reconstruction of the lower eyelid after excision of major tumours. Acta Chir Plast. 1993;35(3-4):131-45. [Medline].

  5. Bartley GB, Putterman AM. A minor modification of the Hughes' operation for lower eyelid reconstruction. Am J Ophthalmol. Jan 1995;119(1):96-7. [Medline].

  6. Beyer CK, Bathrick ME. One-stage lower eyelid reconstruction. Ophthalmic Surg. Jul 1982;13(7):551-4. [Medline].

  7. Boynton JR. Semicircle flap reconstruction "plus". Ophthalmic Surg. Dec 1993;24(12):826-30. [Medline].

  8. Chandler DB, Gausas RE. Lower eyelid reconstruction. Otolaryngol Clin North Am. Oct 2005;38(5):1033-42. [Medline].

  9. Cohen MS, Shorr N. Eyelid reconstruction with hard palate mucosa grafts. Ophthal Plast Reconstr Surg. 1992;8(3):183-95. [Medline].

  10. Crestinu JM. Reconstruction of the lower eyelid. Plast Reconstr Surg. Oct 1988;82(4):720. [Medline].

  11. Custer PL. Tarsal kinking after Hughes flap. Ophthal Plast Reconstr Surg. Sep 1998;14(5):349-51. [Medline].

  12. Glatt HJ. Tarsoconjunctival flap supplementation: an approach to the reconstruction of large lower eyelid defects. Ophthal Plast Reconstr Surg. Jun 1997;13(2):90-7. [Medline].

  13. Hatoko M, Kuwahara M, Shiba A, Tanaka A, Tada H, Okazaki T. Reconstruction of full-thickness lower eyelid defects using a blepharoplasty technique with a hard palate mucosal graft. Ann Plast Surg. Jun 1999;42(6):688-92. [Medline].

  14. Holds JB, Anderson RL. Medial canthotomy and cantholysis in eyelid reconstruction. Am J Ophthalmol. Aug 15 1993;116(2):218-23. [Medline].

  15. Iliff CE, Iliff NT. Partial and total reconstruction of the lower eyelid. Ophthalmology. Apr 1980;87(4):272-8. [Medline].

  16. Jordan DR, Anderson RL, Holds JB. Modifications to the semicircular flap technique in eyelid reconstruction. Can J Ophthalmol. Apr 1992;27(3):130-6. [Medline].

  17. Leone CR Jr. Periosteal flap for lower eyelid reconstruction. Am J Ophthalmol. Oct 15 1992;114(4):513-4. [Medline].

  18. Lowry JC, Bartley GB, Garrity JA. The role of second-intention healing in periocular reconstruction. Ophthal Plast Reconstr Surg. Sep 1997;13(3):174-88. [Medline].

  19. Matsuo K, Sakaguchi Y, Kiyono M, Hataya Y, Hirose T. Lid margin reconstruction with an orbicularis oculi musculocutaneous advancement flap and a conchal cartilage graft. Plast Reconstr Surg. Jan 1991;87(1):142-5. [Medline].

  20. McCord CD, Nunery WR, Tanenbaum. Reconstruction of the lower eyelid and outer canthus. Oculoplastic Surgery. 1995;119-44.

  21. Mehta HK. Simultaneous spontaneous and primary surgical repair of eyelids. Br J Ophthalmol. Jul 1989;73(7):488-93. [Medline].

  22. Miller EA, Boynton JR. Complications of eyelid reconstruction using a semicircular flap. Ophthalmic Surg. Nov 1987;18(11):807-10. [Medline].

  23. Papp C, Maurer H, Geroldinger E. Lower eyelid reconstruction with the upper eyelid rotation flap. Plast Reconstr Surg. Sep 1990;86(3):563-5; discussion 566-8. [Medline].

  24. Rohrich RJ, Zbar RI. The evolution of the Hughes tarsoconjunctival flap for the lower eyelid reconstruction. Plast Reconstr Surg. Aug 1999;104(2):518-22; quiz 523; discussion 524-6. [Medline].

  25. Steinkogler FJ. Reconstruction of the lower lid. Br J Ophthalmol. Jul 1984;68(7):507-10. [Medline].

 
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Direct layered closure of a lid margin defect, showing placement of tarsal sutures. A - Posterior lid margin; B - Gray line; C - Anterior lid margin.
Tenzel rotation flap with steps outlined.
A - A shallow defect involving almost the whole lower lid appropriate for closure using a modified Hughes flap. B - Preparing the Hughes tarsoconjunctival flap undermining the levator to the superior fornix and leaving at least 4 mm of tarsus for lid stability.
The flap is advanced and the upper tarsus sutured to the lower lid conjunctiva and lower tarsus as shown in detail in A.
Mustarde rotational cheek flap.
 
 
 
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