Aesthetic and Functional Management of Eyelid and Orbital Reconstruction

ABSTRACT

Major head and neck resections may result in ocular defects that are functionally and/or aesthetically incapacitating. Restoration of the eyelid and orbit must address lateral canthal laxity, midface ptosis, eyelid retraction and ptosis, globe malposition, and dysfunctional lacrimal drainage. Here we discuss lateral canthal reconstruction, midface-lifting, eyelid spacer grafts, gold weight placement, surgical approaches to the orbit, free flap options for orbital reconstruction, and endoscopic lacrimal surgery. Successful outcomes in eyelid and orbital reconstruction depend upon proper knowledge, planning, and multidisciplinary management.

KEYWORDS

Eyelids - orbit - midface - reconstructive surgery - oculoplastic surgery - dacryocystorhinostomy

REFERENCES

• 1 McCord C D, Boswell C B, Hester T R. Lateral canthal anchoring.  Plast Reconstr Surg. 2003;  112 222-239
• 2 Flowers R S, Nassif J M, Rubin P A, Hayakawa T, Lehr S K. A key to canthopexy: the tarsal strap. A fresh cadaveric study.  Plast Reconstr Surg. 2005;  116 1752-1760
• 3 Anderson R L, Gordy D D. The tarsal strip procedure.  Arch Ophthalmol. 1979;  97 2192-2196
• 4 Gunter J P, Hackney F L. A simplified transblepharoplasty subperiosteal cheek lift.  Plast Reconstr Surg. 1999;  103 2029-2041
• 5 Li T G, Shorr N, Goldberg R A. Comparison of the efficacy of hard palate grafts with acellular human dermis grafts in lower eyelid surgery.  Plast Reconstr Surg. 2005;  116 873-878
• 6 Patel M P, Shapiro M D, Spinelli H M. Combined hard palate spacer graft, midface suspension, and lateral canthoplasty for lower eyelid retraction: a tripartite approach.  Plast Reconstr Surg. 2005;  115 2105-2114
• 7 Sullivan S A, Dailey R A. Graft contraction: a comparison of acellular dermis versus hard palate mucosa in lower eyelid surgery.  Ophthal Plast Reconstr Surg. 2003;  19 14-24
• 8 Kim J W, Kikkawa D O, Lemke B N. Donor site complications of hard palate mucosal grafting.  Ophthal Plast Reconstr Surg. 1997;  13 36-39
• 9 Malhotra R, Selva D. Free tarsus autogenous graft struts for lower eyelid elevation.  Ophthal Plast Reconstr Surg. 2005;  21 117-122
• 10 Shorr N, Perry J D, Goldberg R A, Hoenig J, Shorr J. The safety and applications of acellular human dermal allograft in ophthalmic plastic and reconstructive surgery: a preliminary report.  Ophthal Plast Reconstr Surg. 2000;  16 223-230
• 11 Tan J, Olver J, Wright M, Maini R, Neoh C, Dickinson A J. The use of porous polyethylene (Medpor) lower eyelid spacers in lid heightening and stabilisation.  Br J Ophthalmol. 2004;  88 1197-1200
• 12 Clark J M, Shockley W W. Management and Reanimation of the Paralyzed Face. In: Papel ID, Frodel J, Holt GR Facial Plastic and Reconstructive Surgery. New York; Thieme Medical Publishers, Inc 2002
• 13 Lorenz H P, Longaker M T, Kawamoto H K. Primary and secondary orbit surgery: the transconjunctival approach.  Plast Reconstr Surg. 1999;  103 1124-1128
• 14 Chepeha D B, Wang S J, Marentette L J et al.. Restoration of the orbital aesthetic subunit in complex midface defects.  Laryngoscope. 2004;  114 1706-1713
• 15 Cordeiro P G, Santamaria E, Kraus D H, Strong E W, Shah J P. Reconstruction of total maxillectomy defects with preservation of the orbital contents.  Plast Reconstr Surg. 1998;  102 1874-1884
• 16 Cordeiro P G, Disa J J. Challenges in midface reconstruction.  Semin Surg Oncol. 2000;  19 218-225
• 17 Futran N D, Mendez E. Developments in reconstruction of midface and maxilla.  Lancet Oncol. 2006;  7 249-258
• 18 Hashikawa K, Terashi H, Tahara S. Therapeutic strategy for the triad of acquired anophthalmic orbit.  Plast Reconstr Surg. 2007;  119 2182-2188
• 19 Zhang R. Reconstruction of the anophthalmic orbit by orbital osteotomy and free flap transfer.  Journal of Plastic and Reconstructive & Aesthetic Surgery: JPRAS. 2007;  60 232-240
• 20 Baker S R. Closure of large orbital-maxillary defects with free latissimus dorsi myocutaneous flaps.  Head Neck Surg. 1984;  6 828-835
• 21 Pryor S G, Moore E J, Kasperbauer J L. Orbital exenteration reconstruction with rectus abdominis microvascular free flap.  Laryngoscope. 2005;  115 1912-1916
• 22 Chepeha D B, Moyer J S, Bradford C R, Prince M E, Marentette L, Teknos T N. Osseocutaneous radial forearm free tissue transfer for repair of complex midfacial defects.  Arch Otolaryngol Head Neck Surg. 2005;  131 513-517
• 23 Triana Jr R J, Uglesic V, Virag M et al.. Microvascular free flap reconstructive options in patients with partial and total maxillectomy defects.  Arch Facial Plast Surg. 2000;  2 91-101
• 24 Futran N D, Wadsworth J T, Villaret D, Farwell D G. Midface reconstruction with the fibula free flap.  Arch Otolaryngol Head Neck Surg. 2002;  128 161-166
• 25 Genden E M, Wallace D, Buchbinder D, Okay D, Urken M L. Iliac crest internal oblique osteomusculocutaneous free flap reconstruction of the postablative palatomaxillary defect.  Arch Otolaryngol Head Neck. 2001;  127 854-861
• 26 Watkins L M, Janfaza P, Rubin P A. The evolution of endonasal dacryocystorhinostomy.  Surv Ophthalmol. 2003;  48 73-84
• 27 Woog J J, Sindwani R. Endoscopic dacryocystorhinostomy and conjunctivodacryocystorhinostomy.  Otolaryngol Clin North Am. 2006;  39 1001-1017
• 28 Tsirbas A, Wormald P J. Mechanical endonasal dacryocystorhinostomy with mucosal flaps.  Otolaryngol Clin North Am. 2006;  39 1019-1036
• 29 Durvasula V S, Gatland D J. Endoscopic dacrocystorhinostomy: long-term results and evolution of surgical technique.  J Laryngol Otol. 2004;  118 628-632
• 30 Duffy M T. Advances in lacrimal surgery.  Curr Opin Ophthal. 2000;  11 352-356