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EYELID RECONSTRUCTION

EYELID RECONSTRUCTION. AN OVERVIEW. EYELID RECONSTRUCTION. AIMS MAINTAIN FUNCTION & INTEGRITY OF PERIORBITAL STRUCTURES ACHIEVE OPTIMAL COSMESIS. EYELID RECONSTRUCTION. GOALS SMOOTH MUCOSA-LIKE INTERNAL LINING STABLE EYELID MARGIN WITH LASHES PROJECTING AWAY FROM THE GLOBE

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EYELID RECONSTRUCTION

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  1. EYELID RECONSTRUCTION AN OVERVIEW

  2. EYELID RECONSTRUCTION AIMS MAINTAIN FUNCTION & INTEGRITY OF PERIORBITAL STRUCTURES ACHIEVE OPTIMAL COSMESIS

  3. EYELID RECONSTRUCTION GOALS • SMOOTH MUCOSA-LIKE INTERNAL LINING • STABLE EYELID MARGIN WITH LASHES PROJECTING AWAY FROM THE GLOBE • LID RIGIDITY OF THE TARSAL AND CANTHAL AREAS • FUNCTIONAL RETRACTORS • ADEQUATE CLOSURE FOR PROTECTION AND LUBRICATION • ACCEPTABLE COSMESIS

  4. EYELID RECONSTRUCTION • ANATOMY • EYELID POSITION HALFWAY BETWEEN PUPIL & LIMBUS – NORMAL EXCURSION 16MM • CANTHAL POSITION - LATERAL AGAINST GLOBE • MEDIAL, SEPARATION BY LACRIMAL CARUNCLE

  5. EYELID ANATOMY • LATERAL ANGLE 2-3MM HIGHER THAN THE MEDIAL CANTHAL AREA • EYELIDS TWO LAMELLA ANTERIOR - SKIN AND MUSCLE, POSTERIOR - CONJUNCTIVA TARSAL PLATE LID RETRACTORS

  6. EYELID ANATOMY • LID MARGIN 2MM THICK • ANTERIOR EYELASHES • POSTERIOR MEIBOMIAN GLAND ORIFICES • GREY LINE SEPERATES TWO AREAS

  7. EYELID ANATOMY • PUNCTUM • INFERIOR TYPICALLY 2MM LATERAL TO SUPERIOR • BLOOD SUPPLY • MARGINAL ARTERY 3-4MM FROM MARGIN

  8. LACRIMAL SYSTEM • LACRIMAL GLAND • LACRIMAL DRAINAGE SYSTEM • PUNCTA UPPER AND LOWER CANALICULI • LACRIMAL SAC AND NASO-LACRIMAL DUCT

  9. PREPARATION • GLOBE PROTECTION • LUBRICATION • CORNEAL PROTECTOR • SUTURE PLACEMENT • ANAESTHESIA – • LOCAL, GENERAL, TOPICAL • WOUND PREPARATION – • MINIMAL DEBRIDEMENT

  10. DEFECTS • UPPER • LOWER • DO NOT USE UPPER LID FOR LOWER LID DEFECTS

  11. LOWER LID DEFECTS • PARTIAL • FULL THICKNESS

  12. LOWER LID DEFECTS • PARTIAL – • PRIMARY CLOSURE • FLAPS • FULL THICKNESS GRAFT

  13. Direct Closure

  14. PRIMARY CLOSURE • VERTICAL NOT HORIZONTAL • PENTAGONAL= NO NOTCH

  15. FULLTHICKNESS GRAFT • UPPER LID • EXCESS SKIN • POST AURICULAR • ? 2 SSG • PRE AURICULAR • THICKER & LIMITED • SUPRACLAVICULAR • THICKER, COLOUR MATCH NOT AS GOOD

  16. FLAPS • VY • FROM CHEEK • TRANSPOSITION • GLABELLA, NASOLABIAL, EYELID OR BROW • ROTATION ADVANCEMENT • CHEEK

  17. LOWER LID DEFECTS • FULL THICKNESS • EXTENSILE APPROACH • ¼ TO 1/3 • COMPOSITE GRAFT FROM OPPOSITE LID, • UP TO 50%. • LATERAL CANTHOTOMY • GREATER THAN 50% • CHEEK ROTATION OR VY FLAP AND MUCOCHONDRAL GRAFT

  18. LOWER LID DEFECTS • FULL THICKNESS • EXTENSILE APPROACH

  19. LOWER LID DEFECTS • FULL THICKNESS • EXTENSILE APPROACH

  20. LOWER LID DEFECTS • FULL THICKNESS • EXTENSILE APPROACH

  21. LOWER LID DEFECTS • FULL THICKNESS • EXTENSILE APPROACH

  22. LOWER LID DEFECTS • FULL THICKNESS • EXTENSILE APPROACH

  23. LOWER LID DEFECTS • FULL THICKNESS NB ? NEED FOR MUCOUS LINING IN LOWER LID DEFECTS.

  24. SOURCE OF CHONDRO- MUCOSAL GRAFT

  25. UPPER LID DEFECTS • PARTIAL THICKNESS • DIRECT CLOSURE • LOCAL FLAP • FTG FROM OTHER LID • DISTANT FLAP • TEMPLE FLAP

  26. UPPER LID DEFECTS • FULL THICKNESS • SIMILAR CONSIDERATIONS TO LOWER EYELID.

  27. UPPER LID DEFECTS • FULL THICKNESS • SIMILAR CONSIDERATIONS TO LOWER EYELID.

  28. UPPER LID DEFECTS • FULL THICKNESS • SIMILAR CONSIDERATIONS TO LOWER EYELID.

  29. UPPER LID DEFECTS • FULL THICKNESS • SIMILAR CONSIDERATIONS TO LOWER EYELID.

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