Eyelid Reconstruction

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CLASSIFICATION OF PTOSIS Congenital ptosis 1. Simple 2. With lid anomalies 3. With ophthalmoplegias 4. Synkinetic (Marcus-Gunn) Acquired ptosis 1. Neurogenic 2. Myogenic 3. Traumatic 4. Mechanical 5. Pseudoptosis • Congenital ptosis is associated with myogenic dystrophic changes of the levator muscle resulting in poor levator function • A small percentage of these changes include two types: misdirected third cranial nerve (CN III) ptosis of the Marcus-Gunn type & blepharophimosis 50
• Neurogenic ptosis includes CN III palsy, congenital or acquired, and Horner’s cervical sympathetic nerve palsy • Myogenic ptosis includes ―involutional‖ or senile ptosis; acquired muscular dystrophy; progressive external ophthalmoplegia; and myasthenia gravis • Traumatic ptosis varies according to the location of the injury to the levator muscle or lid mechanism • Mechanical ptosis is due to a tumor, cyst, or enlarged lacrimal gland pushing down the eyelid • Pseudoptosis refers to the drooping lid skin of blepharochalasis and to the apparent ptosis seen in the postenucleation eyelid • Before proceeding with surgery in the ptosis patient, it is wise to make a detailed evaluation of the history and development of the problem 51
Page 1 and 2: Eyelid Reconstruction Introduction
Page 3 and 4: Anatomy Tarsus - Dense, fibrous ti
Page 5 and 6: Anatomy Orbital Septum - Fascial b
Page 7 and 8: • Lower - marginal artery • Up
Page 9 and 10: • V - median palpebral arterial v
Page 11 and 12: Anatomy Anatomy 11
Page 13 and 14: Anatomy Lateral canthal tendon - l
Page 15 and 16: Anatomy Lacrimal Excretory Pump Lac
Page 17 and 18: Eyelid Reconstruction • Skin graf
Page 19 and 20: Lower Eyelid Reconstruction PARTIAL
Page 21 and 22: Direct Closure 30% defects in youn
Page 23 and 24: The “extensile” approach: A:
Page 25 and 26: C: If lateral cantholysis is not ad
Page 27 and 28: Mustarde Rotational Cheek Flap Goo
Page 29 and 30: • Over correction in the vertical
Page 31 and 32: Free Tarsal Graft Tripier bipedicle
Page 33 and 34: Hughes Procedure (continued) ―Use
Page 35 and 36: ― Medial canthal reconstruction u
Page 37 and 38: • An excellent flap for local cov
Page 39 and 40: Sliding Tarsoconjunctival Flap Iso
Page 41 and 42: Posterior Lamellar Graft with Local
Page 43 and 44: Pedicle Flap From Lower Lid Full-th
Page 45 and 46: Lateral Canthal Reconstruction Late
Page 47 and 48: Medial Canthal Reconstruction Relat
Page 49: CORRECTION OF PTOSIS • When deali
Page 53 and 54: • Previous problems:excessive tea
Page 55 and 56: B: Fascia is inserted between the o
Page 57 and 58: Mild/Moderate ptosis with fair to g
Page 59 and 60: Mustarde’s “split-level” tars
Page 61 and 62: • The usual amount of plication i
Page 63 and 64: ― Aesthetic eyelid ptosis correct
Page 65 and 66: • Loss of eyelashes: may occur, p
Page 67 and 68: Entropion Correction of congenital
Page 69 and 70: Entropion Correction of involution
Page 71 and 72: Entropion Correction of cicatricia
Page 73 and 74: Ectropion Congenital - Insufficien
Page 75 and 76: Ectropion Correction of paralytic
Page 77 and 78: Ectropion Correction of cicatricia
Page 79 and 80: Ectropion Correction of involution

Eyelid Reconstruction

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