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EYELID RECONSTRUCTION AN OVERVIEW. EYELID RECONSTRUCTION AIMS  MAINTAIN FUNCTION & INTEGRITY OF PERIORBITAL STRUCTURES  ACHIEVE OPTIMAL COSMESIS.

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Presentation on theme: "EYELID RECONSTRUCTION AN OVERVIEW. EYELID RECONSTRUCTION AIMS  MAINTAIN FUNCTION & INTEGRITY OF PERIORBITAL STRUCTURES  ACHIEVE OPTIMAL COSMESIS."— Presentation transcript:

1 EYELID RECONSTRUCTION AN OVERVIEW

2

3 EYELID RECONSTRUCTION AIMS  MAINTAIN FUNCTION & INTEGRITY OF PERIORBITAL STRUCTURES  ACHIEVE OPTIMAL COSMESIS

4 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

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

6 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

7 EYELID ANATOMY  LID MARGIN 2MM THICK  ANTERIOR EYELASHES  POSTERIOR MEIBOMIAN GLAND ORIFICES  GREY LINE SEPERATES TWO AREAS

8 EYELID ANATOMY  PUNCTUM  INFERIOR TYPICALLY 2MM LATERAL TO SUPERIOR  BLOOD SUPPLY  MARGINAL ARTERY 3-4MM FROM MARGIN

9 LACRIMAL SYSTEM LACRIMAL GLAND LACRIMAL DRAINAGE SYSTEM  PUNCTA UPPER AND LOWER CANALICULI  LACRIMAL SAC AND NASO-LACRIMAL DUCT

10 PREPARATION  GLOBE PROTECTION  LUBRICATION  CORNEAL PROTECTOR  SUTURE PLACEMENT  ANAESTHESIA –  LOCAL, GENERAL, TOPICAL  WOUND PREPARATION –  MINIMAL DEBRIDEMENT

11 DEFECTS  UPPER  LOWER  DO NOT USE UPPER LID FOR LOWER LID DEFECTS

12 LOWER LID DEFECTS  PARTIAL  FULL THICKNESS

13 LOWER LID DEFECTS  PARTIAL –  PRIMARY CLOSURE  FLAPS  FULL THICKNESS GRAFT

14 Direct Closure

15 PRIMARY CLOSURE  VERTICAL NOT HORIZONTAL  PENTAGONAL= NO NOTCH

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

17 FLAPS  VY  FROM CHEEK  TRANSPOSITION  GLABELLA, NASOLABIAL, EYELID OR BROW  ROTATION ADVANCEMENT  CHEEK

18 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

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 EXTENSILE APPROACH

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

25 SOURCE OF CHONDRO- MUCOSAL GRAFT

26 UPPER LID DEFECTS -PARTIAL THICKNESS -DIRECT CLOSURE - LOCAL FLAP -FTG FROM OTHER LID - DISTANT FLAP - TEMPLE FLAP

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.

30 UPPER LID DEFECTS - FULL THICKNESS -SIMILAR CONSIDERATIONS TO LOWER EYELID.


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