Subperiosteal Midface Lift with or without a Hard Palate Mucosal Graft for Correction of Lower Eyelid Retraction

Department of Ophthalmology, University of California, Los Angeles, Los Ángeles, California, United States
Ophthalmology (Impact Factor: 6.14). 10/2006; 113(10):1869-73. DOI: 10.1016/j.ophtha.2006.05.014
Source: PubMed


To compare functional and surgical outcomes of a subperiosteal midface lift with and without the placement of a hard palate mucosal graft (HPMG) in patients with lower eyelid retraction.
Retrospective, comparative, interventional case series.
Thirty-four patients with lower eyelid retractions who underwent surgery at the Jules Stein Eye Institute in a 5-year period.
Medical record review of all patients who underwent surgery for lower eyelid retraction by a subperiosteal midface lift with or without an HPMG. Preoperative and postoperative digital photographs were taken in all patients.
Change in margin reflex distance 2 (MRD2), measured from the pupillary margin to the upper margin of the lower eyelid; patient discomfort; and surgical complications.
Thirty-four patients (20 female; mean age, 64 years) participated in the study; 11 underwent bilateral surgery, with overall 43 surgeries performed. Eighteen patients (42%) had lower eyelid retraction secondary to previous transcutaneous lower eyelid blepharoplasty. Postoperatively, patients attained a better lower eyelid position, with improvement of lower eyelid height of 1.4 mm (P<0.001, 1-sample t test). Patients operated using an HPMG (12 surgeries) achieved a greater reduction in MRD2 postoperatively as compared with patients operated by subperiosteal midface lift alone (31 surgeries; 2.2 mm vs. 1.1 mm, respectively; P = 0.02, Wilcoxon Mann-Whitney). One patient needed reoperation secondary to symptomatic lower eyelid retraction postoperatively.
The subperiosteal midface lift is effective in correction of lower eyelid retraction of various causes. The use of an HPMG spacer may enhance surgical outcomes and results in a better lower eyelid position.

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    • "Hard palate or nasal turbinate mucosal tissue is often used as an autologous spacer since the surfaces of these tissues possess an appropriate degree of rigidity.10-12 Although keratinization can occur, it only irritates the ocular surface.9,12,13 As an alternative spacer material, auricular cartilage can be utilized. "
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    • "The hard palate mucosa and nasal turbinate mucosa are often used as autologous spacers (Bartley and Kay 1989; Kersten et al 1990; Cohen and Shorr 1992; Wearne et al 2001; Patel et al 2005; Ben Simon et al 2006), since they have a mucosal surface of appropriate rigidity (Cohen and Shorr 1992; Wearne et al 2001). Although keratinization can occur, it only irritates the ocular surface (Kersten et al 1990; Ben Simon et al 2006; Cohen and Shorr 1992). As an alternative material, ear cartilage is sometimes used via a transconjunctival approach (Baylis et al 1985; Moon et al 2005), and some of this remains exposed and requires removal (Kersten et al 1990). "
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