Upper Eyelid Reconstruction Procedures 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, such as 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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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

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

  2. Codner MA, Weinfeld AB. Pr47 comprehensive eyelid reconstruction. ANZ J Surg. May 2007;77 Suppl 1:A71. [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. Achauer BM, Menick FJ. Salvage of seeing eyes after avulsion of upper and lower lids. Plast Reconstr Surg. Jan 1985;75(1):11-6. [Medline].

  5. Avram DR, Hurwitz JJ, Kratky V. Modified Tessier flap for reconstruction of the upper eyelid. Ophthalmic Surg. Aug 1991;22(8):467-9. [Medline].

  6. Beyer-Machule CK, Shapiro A, Smith B. Double composite lid reconstruction: a new method of upper and lower lid reconstruction. Ophthal Plast Reconstr Surg. 1985;1(2):97-102. [Medline].

  7. Boynton JR. Subtotal reconstruction of the upper eyelid. A one-stage procedure eliminating temporary lid closure. Arch Ophthalmol. Feb 1985;103(2):288-9. [Medline].

  8. Carraway JH. Aesthetic approach to upper eyelid reconstruction. Clin Plast Surg. Apr 1981;8(2):237-41. [Medline].

  9. Divine RD, Anderson RL. Techniques in eyelid wound closure. Ophthalmic Surg. Apr 1982;13(4):283-7. [Medline].

  10. Hauben DJ, Tessler Z. One-stage reconstruction of a large upper lid defect in a newborn. Plast Reconstr Surg. Feb 1989;83(2):337-40. [Medline].

  11. Jordan DR, Anderson RL, Nowinski TS. Tarsoconjunctival flap for upper eyelid reconstruction. Arch Ophthalmol. Apr 1989;107(4):599-603. [Medline].

  12. Kadoi C, Hayasaka S, Kato T, Nagaki Y, Matsumoto M, Hayasaka Y. The cutler-beard bridge flap technique with use of donor sclera for upper eyelid reconstruction. Ophthalmologica. 2000;214(2):140-2. [Medline].

  13. Kersten RC, Anderson RL, Tse DT, Weinstein GL. Tarsal rotational flap for upper eyelid reconstruction. Arch Ophthalmol. Jun 1986;104(6):918-22. [Medline].

  14. Leone CR Jr. Tarsal-conjunctival advancement flaps for upper eyelid reconstruction. Arch Ophthalmol. Jun 1983;101(6):945-8. [Medline].

  15. Mauriello JA Jr, Antonacci R. Single tarsoconjunctival flap (lower eyelid) for upper eyelid reconstruction ("reverse" modified Hughes procedure). Ophthalmic Surg. Jun 1994;25(6):374-8. [Medline].

  16. McGregor IA. Eyelid reconstruction following subtotal resection of upper or lower lid. Br J Plast Surg. Oct 1973;26(4):346-54. [Medline].

  17. Okada E, Iwahira Y, Maruyama Y. The V-Y advancement myotarsocutaneous flap for upper eyelid reconstruction. Plast Reconstr Surg. Sep 1997;100(4):996-8. [Medline].

  18. Petersen NC. Reconstruction of the upper eyelid ad modum Cutler and Beard. Acta Ophthalmol (Copenh). 1969;47(1):228-33. [Medline].

  19. Pham RT. Reconstruction of the upper eyelid. Otolaryngol Clin North Am. Oct 2005;38(5):1023-32. [Medline].

  20. Putterman AM. Wedge resection of eyelid margin in the treatment of abnormal eyelid margins. Arch Ophthalmol. Nov 1995;113(11):1458-9. [Medline].

  21. Tenzel RR, Stewart WB. Eyelid reconstruction by the semicircle flap technique. Ophthalmology. Nov 1978;85(11):1164-9. [Medline].

  22. Wesley RE, McCord CD. Reconstruction of the upper eyelid and medial canthus. Oculoplastic Surgery. 1995;99-117.

 
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(A) The correct pentagonal wedge excision that should be used in the upper lid. (B) and (C) Incorrect wedge excisions leading to lid notching and kinking.
Layered suture closure of lid margin defect.(A) Excision of lesion. (B) 6-0 Vicryl sutures through tarsus. (C) Either 6-0 silk or 6-0 gut sutures for the margins. (D) Skin closure with interrupted 6-0 silk or 6-0 gut sutures.
(A) Large upper lid defect. (B) Tarsus conjunctival flap fashioned. (C) Flap moved horizontally to fill in defect, with edges sutured to orbital rim and levator remnants. (D) Lid margin suture placed. (E) Skin graft placed.
Tenzel flap for upper lid.
Cutler-Beard flap.
 
 
 
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