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Disclosure of Relevant Financial Interests for All Authors

Reconstruction of the Severely Scarred and Displaced Lower Eyelid Following Violation of All Three Lamellar Planes. Jason Roostaeian, MD, Emil Kohan, MD, Neil Tanna, MD, Henry K. Kawamoto MD, DDS, James P. Bradley, MD Mattel Children’s Hospital UCLA Ronald Reagan Medical Center.

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Disclosure of Relevant Financial Interests for All Authors

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  1. Reconstruction of the Severely Scarred and Displaced Lower Eyelid Following Violation of All Three Lamellar Planes Jason Roostaeian, MD, Emil Kohan, MD, Neil Tanna, MD, Henry K. Kawamoto MD, DDS, James P. Bradley, MD Mattel Children’s Hospital UCLA Ronald Reagan Medical Center

  2. Disclosure of Relevant Financial Interests for All Authors “Nothing to disclose”

  3. Trilamellar Lower Eyelid Reconstruction Severe Lower Eyelid Scarring Traumatic violation of all three lamellae leads to severe scarring Post-traumatic full-thickness lower eyelid injury Post-surgical: Trans-conjunctival incision after partial thickness anterior scar Post-traumatic Lower Eyelid Scar

  4. Trilamellar Lower Eyelid Reconstruction Objective Evaluate staged operative approach for symptomatic improvement Post-surgical Lower Eyelid Scar

  5. Trilamellar Lower Eyelid Reconstruction Methods First Stage: • Palatal Graft Mid/Posterior lamellae • FTSG  Anterior lamella Second Stage: • Fat grafting  Spacer

  6. Trilamellar Lower Eyelid Reconstruction Methods First Stage: • Palatal Graft Mid/Posterior lamellae • FTSG  Anterior lamella Second Stage: • Fat grafting  Spacer

  7. Trilamellar Lower Eyelid Reconstruction Methods First Stage: • Palatal Graft Mid/Posterior lamellae • FTSG  Anterior lamella Second Stage: • Fat grafting  Spacer

  8. Trilamellar Lower Eyelid Reconstruction Methods First Stage: • Palatal Graft Mid/Posterior lamellae • FTSG  Anterior lamella • Canthopexy Second Stage: • Fat grafting  Spacer

  9. Trilamellar Lower Eyelid Reconstruction Cadaveric Anatomic Dissection Cross-section / Reconstruction Showed consistent anatomy Tarsal plate=10-12 mm Palatal graft support but pliable PG orbital rim Cadaver specimens (n=20)

  10. Trilamellar Lower Eyelid Reconstruction UCLA Clinical Review Lower eyelid reconstruction (1999-2008) (n=52) • Ectropion (eversion): 51% • Entropion (inversion): 30% • Full-thickness Scar: 19% or n=10 Underwent described staged technique

  11. Trilamellar Lower Eyelid Reconstruction Results Mechanism: • 75%  Full-thickness injury • 25%  After transconjunctival incision with partial injury MVA = 60% Assault = 40% Preoperative Postoperative

  12. Trilamellar Lower Eyelid Reconstruction Results Timing: • 9.1 months after injury (range=6-17 mths) Procedures: • 2.6 required Preoperative Postoperative

  13. Trilamellar Lower Eyelid Reconstruction Results Symptoms: • Preop: Epiphora (90%), tearing (100%), redness (100%), Blurring vision (80%), dryness (80%) • Postop: Epiphora (0%), tearing (0%), redness (0%), Blurring vision (10%), dryness (20%) Preoperative Postoperative

  14. Trilamellar Lower Eyelid Reconstruction Results Complications: (40%) • Redundant palatal graft (office excision) • Partial loss FTSG (healed secondarily) • Cellulitis after fat graft (resolved abx) Preoperative Postoperative

  15. Trilamellar Lower Eyelid Reconstruction Conclusions • Our staged approach for reconstruction of scarred/displaced lower eyelid provided symptomatic improvement. • We suggest caution with transconjunctival approach following partial lower eyelid injury.

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