Post-traumatic-iatrogenic ectropion Our experience of aesthetic and functional
correction
Lambros ZOULOUMIS, Ioannis AETOPOULOS, Ioannis TILAVERIDIS, Maria LAZARIDOU, Gregory VENETIS, Nikolaos LAZARIDIS
Oral and Maxillofacial Surgery Clinic, Dental School, Aristotle University of Thessaloniki, ‘G. Papanikolaou’ General Hospital. (Head: Professor K. Antoniadis)
Hellenic Archives of Oral & Maxillofacial Surgery (2014) 3, 107-120
SUMMARY: Ectropion is a pathological condition usually affecting the lower eyelid and especially its margin which droops and rotates outwards. Ectropion may be acquired (involutional, mechanical, paralytic or cicatricial) or congenital. The pathological entity can result following damage of the basic anatomical structures of the eyelid, such as injury-induced scarring of the skin, burns or postoperative scarring. Its correction is deemed necessary due to the resulting aesthetic and functional problems, and can be achieved mainly by surgical means. One of the main surgical procedures involves the use of local skin flaps, such as nasolabial ones, advancement buccal flaps, Tenzel rotational flap, Tripier and Mustardè flaps. Aim of the present paper is to present the 10year experience of treating patients with post-traumatic/post-operative cicatricial ectropion of the lower eyelid, using local skin flaps, and more precisely nasolabial, buccal advancement, Tripier and Mustardè flaps. The above mentioned surgical procedures were used in 14 patients. No intra- or postoperative complications were observed. The immediate postoperative and long-term results were satisfactory in both aesthetic and functional terms. The restoration of the lower eyelid function was immediate and satisfactory in all cases, with no relapses.
KEY WORDS: ectropion, eyelid, treatment, treatment methods, flap
REFERENCES
Abrams JD: Simple technique for splitting the lid in the Kuhnt-Szymanowski ectropion operation. Br J Ophthalmol 48:55, 1964
Actis AG, Actis G: Reconstruction of the upper eyelid with flaps and free grafts after excision of Basal cell carcinoma. Case Rep Ophthalmol 2(3):347-53, 2011 Barrett RV, Meyer DR: The modified Bick quick strip procedure for surgical treatment of eyelid malposition. Ophthal Plast Reconstr Surg 28(4):294-9, 2012 Bellaney GJ: Scarring of the eyelids from Coblation treatment. Australas J Dermatol 45(3):170-1, 2004
Blanco G, Clavero A, Soparkar CN, Patrinely JR: Periocular laser complications. Semin Plast Surg 21(1):74-9, 2007
Britt MT, Burnstine MA: Iopidine allergy causing lower eyelid ectropion progressing to cicatricial entropion. Br J Ophthalmol 83(8):992-3, 1999
Burroughs JR, Soparkar CN, Patrinely JR: Rotation mattress suture: a powerful adjunct for ectropion correction. Ophthal Plast Reconstr Surg 19(5):404-6, 2003
Caviggioli F, Klinger F, Villani F, Fossati C, Vinci V, Klinger M: Correction of cicatricial ectropion by autologous fat graft. Aesthetic Plast Surg 32(3):555-7, 2008 Chang L, Olver J: A useful augmented lateral tarsal strip tarsorrhaphy for paralytic ectropion. Ophthalmology 113(1):84-91, 2006
Chua J, Choo CT, Seah LL, Fong KS, Chee SP, Chuah CT, Looi A: A 5-year retrospective review of Asian ectropion: how does it compare to ectropion amongst non-Asians? Ann Acad Med Singapore 40(2):84-9, 2011
Collin JRO: A Manual of Systematic Eyelid Surgery. Elsevier 2006, pp. 12-84 Craiglow BG, Choate KA, Milstone LM: Topical tazarotene for the treatment of ectropion in ichthyosis. JAMA Dermatol 149(5):598- 600, 2013
Elliot D, Britto JA: Tripier's innervated myocutaneous flap 1889. Br J Plast Surg 57(6):543-9, 2004
El-Marakby HH: The versatile naso-labial flaps in facial reconstruction. J Egypt Natl Canc Inst 17(4):245-50, 2005
Garza RM, Lee GK, Press BH: Tarsal ectropion repair and lower blepharoplasty: A case report and review of literature. J Plast Reconstr Aesthet Surg 65(2):249-51, 2012
Goel R, Kamal S, Bodh SA, Kumar S, Kishore J, Malik KP, Singh M, Bansal S: Lower eyelid suspension using polypropylene suture for the correction of punctal ectropion. J Craniomaxillofac Surg 41(7):111-6, 2013
Hesse RJ: Medial ectropion repair of lower eyelids with a cicatricial component. Ochsner J 11(2):122-4, 2011
Kim HJ, Hayek B, Nasser Q, Esmaeli B: Viability of full-thickness skin grafts used for correction of cicatricial ectropion of lower eyelid in previously irradiated field in the periocular region. Head Neck 35(1):103-8, 2013
Kim HS, Kim JW, Yu DS: Semicircular (Tenzel) flap for malignant melanoma involving the palpebral conjunctiva and skin of an eyelid. J Eur Acad Dermatol Venereol 22(1):102-3, 2008
Manku K, Leong JK, Ghabrial R: Cicatricial ectropion: repair with myocutaneous flaps and canthopexy. Clin Experiment Ophthalmol 34(7):677-81, 2006 Moschella F, Cordova A, Di Gregorio C: Lower eyelid reconstruction by multiple subcutaneous pedicle flaps: a new method. Br J Plast Surg 45(1):55-8, 1992 Nikkhah D, Abood A, Watt D: Cicatricial ectropion: a complication of topical 5-fluorouracil. J Plast Reconstr Aesthet Surg 65(1):9-10, 2012
Ozgur OR, Akcay L, Tutas N, Ozkurt Y: Cicatricial upper and lower eyelid ectropion in an ichthyosis patient. Surgical correction. J Dermatol Case Rep 5(2):27-9, 2011
Parodi PC, Calligaris F, De Biasio F, De Maglio G, Miani F, Zeppieri M: Lower lid reconstruction utilizing auricular conchal chondral-perichondral tissue in patients with neoplastic lesions. Biomed Res Int 2013:837536, 2013
Pérez-Dieste JM, Castroviejo-Bolíbar M: Eyelid ectropion caused by glasses. Mechanical centurion syndrome. Arch Soc Esp Oftalmol 88(2):80-2, 2013 Piskiniene R: Eyelid malposition: lower lid entropion and ectropion. Medicina (Kaunas) 42(11):881-4, 2006
Procianoy F, Barbato MT, Osowski LE, Bocaccio FJ, Bakos L: Cicatricial ectropion correction in a patient with pyoderma gangrenosum: case report. Arq Bras Oftalmol 72(3):384-6, 2009
Qian JG, Wang XJ, Wu Y: Severe cicatrical ectropion: repair with a large advancement flap and autologous fascia sling. J Plast Reconstr Aesthet Surg 59(8):878-81, 2006
Rai A, Datarkar A, Rai M: Is buccal fat pad a better option than nasolabial flap for reconstruction of intraoral defects after surgical release of fibrous bands in patients with oral submucous fibrosis? A pilot study: A protocol for the management of oral submucous fibrosis. J Craniomaxillofac Surg S1010-5182(13)00201-1, 2013
Rubin P, Mykula R, Griffiths RW: Ectropion following excision of lower eyelid tumours and full thickness skin graft repair. Br J Plast Surg 58(3):353-60, 2005 Salgarelli AC, Bellini P, Multinu A, Landini B, Consolo U: Tarsal strip technique for correction of malposition of the lower eyelid after treatment of orbital trauma. Br J Oral Maxillofac Surg 47(4):298- 301, 2009
Salgarelli AC, Francomano M, Magnoni C, Bellini P: Cicatricial iatrogenic lower eyelid malposition in skin cancer surgery: results of a combined approach. J Craniomaxillofac Surg 40(7):579-83, 2012
Schrom T, Habermann A: Temporary ectropion therapy by adhesive taping: a case study. Head Face Med 4:12, 2008
Shah J, Patel SG, Singh B: Head and Neck Surgery and Oncology. Chapter 3. Scalp and skin. Elsevier Mosby 2012, p.56 Singh S, Singh RK, Pandey M: Nasolabial flap reconstruction in oral cancer. World J Surg Oncol 10:227, 2012
Tse DT, Neff AG: Ectropion, In: William P. Chen: Occuloplastic Surgery. The Essentials. Thieme Medical Publishers 2001, p.62
Varghese BT, Sebastian P, Cherian T, Mohan PM, Ahmed I, Koshy CM, Thomas S: Nasolabial flaps in oral reconstruction: an analysis of 224 cases. Br J Plast Surg 54(6):499-503, 2001
Verna G, Boriani F, Taveggia A, Fraccalvieri M: The Tripier reverse flap for reconstruction of the upper eyelid. Ann Ital Chir 80(4):311-3, 2009 Vuppalapati G, Niranjan N: Islanded tripier flap--another useful variant. Br J Plast Surg 58(6):882-4, 2005
Wetton L, Wijewardena A, Miroshnik M, Vandervord J: A split forehead flap for the treatment of resistant bilateral upper and lower eyelid ectropion postburn injury. Eplasty 12:18, 2012
Xue CY, Dai HY, Li L, Wang YC, Yang C, Li JH, Xing X: Reconstruction of lower eyelid retraction or ectropion using a paranasal flap. Aesthetic Plast Surg 36(3):611-7, 2012
Zhang Y, Wu HL, Lu YM: Contralateral nasolabial flap for reconstruction of midface defects. Aesthetic Plast Surg 36(5):1175-8, 2012
Ψύλλας ΚΓ: Εισαγωγή στην Οφθαλμολογία και στη Νευροοφθαλμολογία. University Studio Press 1996, σελ. 69-77
Oral and Maxillofacial Surgery Clinic, Dental School, Aristotle University of Thessaloniki, ‘G. Papanikolaou’ General Hospital. (Head: Professor K. Antoniadis)
Hellenic Archives of Oral & Maxillofacial Surgery (2014) 3, 107-120
SUMMARY: Ectropion is a pathological condition usually affecting the lower eyelid and especially its margin which droops and rotates outwards. Ectropion may be acquired (involutional, mechanical, paralytic or cicatricial) or congenital. The pathological entity can result following damage of the basic anatomical structures of the eyelid, such as injury-induced scarring of the skin, burns or postoperative scarring. Its correction is deemed necessary due to the resulting aesthetic and functional problems, and can be achieved mainly by surgical means. One of the main surgical procedures involves the use of local skin flaps, such as nasolabial ones, advancement buccal flaps, Tenzel rotational flap, Tripier and Mustardè flaps. Aim of the present paper is to present the 10year experience of treating patients with post-traumatic/post-operative cicatricial ectropion of the lower eyelid, using local skin flaps, and more precisely nasolabial, buccal advancement, Tripier and Mustardè flaps. The above mentioned surgical procedures were used in 14 patients. No intra- or postoperative complications were observed. The immediate postoperative and long-term results were satisfactory in both aesthetic and functional terms. The restoration of the lower eyelid function was immediate and satisfactory in all cases, with no relapses.
KEY WORDS: ectropion, eyelid, treatment, treatment methods, flap
REFERENCES
Abrams JD: Simple technique for splitting the lid in the Kuhnt-Szymanowski ectropion operation. Br J Ophthalmol 48:55, 1964
Actis AG, Actis G: Reconstruction of the upper eyelid with flaps and free grafts after excision of Basal cell carcinoma. Case Rep Ophthalmol 2(3):347-53, 2011 Barrett RV, Meyer DR: The modified Bick quick strip procedure for surgical treatment of eyelid malposition. Ophthal Plast Reconstr Surg 28(4):294-9, 2012 Bellaney GJ: Scarring of the eyelids from Coblation treatment. Australas J Dermatol 45(3):170-1, 2004
Blanco G, Clavero A, Soparkar CN, Patrinely JR: Periocular laser complications. Semin Plast Surg 21(1):74-9, 2007
Britt MT, Burnstine MA: Iopidine allergy causing lower eyelid ectropion progressing to cicatricial entropion. Br J Ophthalmol 83(8):992-3, 1999
Burroughs JR, Soparkar CN, Patrinely JR: Rotation mattress suture: a powerful adjunct for ectropion correction. Ophthal Plast Reconstr Surg 19(5):404-6, 2003
Caviggioli F, Klinger F, Villani F, Fossati C, Vinci V, Klinger M: Correction of cicatricial ectropion by autologous fat graft. Aesthetic Plast Surg 32(3):555-7, 2008 Chang L, Olver J: A useful augmented lateral tarsal strip tarsorrhaphy for paralytic ectropion. Ophthalmology 113(1):84-91, 2006
Chua J, Choo CT, Seah LL, Fong KS, Chee SP, Chuah CT, Looi A: A 5-year retrospective review of Asian ectropion: how does it compare to ectropion amongst non-Asians? Ann Acad Med Singapore 40(2):84-9, 2011
Collin JRO: A Manual of Systematic Eyelid Surgery. Elsevier 2006, pp. 12-84 Craiglow BG, Choate KA, Milstone LM: Topical tazarotene for the treatment of ectropion in ichthyosis. JAMA Dermatol 149(5):598- 600, 2013
Elliot D, Britto JA: Tripier's innervated myocutaneous flap 1889. Br J Plast Surg 57(6):543-9, 2004
El-Marakby HH: The versatile naso-labial flaps in facial reconstruction. J Egypt Natl Canc Inst 17(4):245-50, 2005
Garza RM, Lee GK, Press BH: Tarsal ectropion repair and lower blepharoplasty: A case report and review of literature. J Plast Reconstr Aesthet Surg 65(2):249-51, 2012
Goel R, Kamal S, Bodh SA, Kumar S, Kishore J, Malik KP, Singh M, Bansal S: Lower eyelid suspension using polypropylene suture for the correction of punctal ectropion. J Craniomaxillofac Surg 41(7):111-6, 2013
Hesse RJ: Medial ectropion repair of lower eyelids with a cicatricial component. Ochsner J 11(2):122-4, 2011
Kim HJ, Hayek B, Nasser Q, Esmaeli B: Viability of full-thickness skin grafts used for correction of cicatricial ectropion of lower eyelid in previously irradiated field in the periocular region. Head Neck 35(1):103-8, 2013
Kim HS, Kim JW, Yu DS: Semicircular (Tenzel) flap for malignant melanoma involving the palpebral conjunctiva and skin of an eyelid. J Eur Acad Dermatol Venereol 22(1):102-3, 2008
Manku K, Leong JK, Ghabrial R: Cicatricial ectropion: repair with myocutaneous flaps and canthopexy. Clin Experiment Ophthalmol 34(7):677-81, 2006 Moschella F, Cordova A, Di Gregorio C: Lower eyelid reconstruction by multiple subcutaneous pedicle flaps: a new method. Br J Plast Surg 45(1):55-8, 1992 Nikkhah D, Abood A, Watt D: Cicatricial ectropion: a complication of topical 5-fluorouracil. J Plast Reconstr Aesthet Surg 65(1):9-10, 2012
Ozgur OR, Akcay L, Tutas N, Ozkurt Y: Cicatricial upper and lower eyelid ectropion in an ichthyosis patient. Surgical correction. J Dermatol Case Rep 5(2):27-9, 2011
Parodi PC, Calligaris F, De Biasio F, De Maglio G, Miani F, Zeppieri M: Lower lid reconstruction utilizing auricular conchal chondral-perichondral tissue in patients with neoplastic lesions. Biomed Res Int 2013:837536, 2013
Pérez-Dieste JM, Castroviejo-Bolíbar M: Eyelid ectropion caused by glasses. Mechanical centurion syndrome. Arch Soc Esp Oftalmol 88(2):80-2, 2013 Piskiniene R: Eyelid malposition: lower lid entropion and ectropion. Medicina (Kaunas) 42(11):881-4, 2006
Procianoy F, Barbato MT, Osowski LE, Bocaccio FJ, Bakos L: Cicatricial ectropion correction in a patient with pyoderma gangrenosum: case report. Arq Bras Oftalmol 72(3):384-6, 2009
Qian JG, Wang XJ, Wu Y: Severe cicatrical ectropion: repair with a large advancement flap and autologous fascia sling. J Plast Reconstr Aesthet Surg 59(8):878-81, 2006
Rai A, Datarkar A, Rai M: Is buccal fat pad a better option than nasolabial flap for reconstruction of intraoral defects after surgical release of fibrous bands in patients with oral submucous fibrosis? A pilot study: A protocol for the management of oral submucous fibrosis. J Craniomaxillofac Surg S1010-5182(13)00201-1, 2013
Rubin P, Mykula R, Griffiths RW: Ectropion following excision of lower eyelid tumours and full thickness skin graft repair. Br J Plast Surg 58(3):353-60, 2005 Salgarelli AC, Bellini P, Multinu A, Landini B, Consolo U: Tarsal strip technique for correction of malposition of the lower eyelid after treatment of orbital trauma. Br J Oral Maxillofac Surg 47(4):298- 301, 2009
Salgarelli AC, Francomano M, Magnoni C, Bellini P: Cicatricial iatrogenic lower eyelid malposition in skin cancer surgery: results of a combined approach. J Craniomaxillofac Surg 40(7):579-83, 2012
Schrom T, Habermann A: Temporary ectropion therapy by adhesive taping: a case study. Head Face Med 4:12, 2008
Shah J, Patel SG, Singh B: Head and Neck Surgery and Oncology. Chapter 3. Scalp and skin. Elsevier Mosby 2012, p.56 Singh S, Singh RK, Pandey M: Nasolabial flap reconstruction in oral cancer. World J Surg Oncol 10:227, 2012
Tse DT, Neff AG: Ectropion, In: William P. Chen: Occuloplastic Surgery. The Essentials. Thieme Medical Publishers 2001, p.62
Varghese BT, Sebastian P, Cherian T, Mohan PM, Ahmed I, Koshy CM, Thomas S: Nasolabial flaps in oral reconstruction: an analysis of 224 cases. Br J Plast Surg 54(6):499-503, 2001
Verna G, Boriani F, Taveggia A, Fraccalvieri M: The Tripier reverse flap for reconstruction of the upper eyelid. Ann Ital Chir 80(4):311-3, 2009 Vuppalapati G, Niranjan N: Islanded tripier flap--another useful variant. Br J Plast Surg 58(6):882-4, 2005
Wetton L, Wijewardena A, Miroshnik M, Vandervord J: A split forehead flap for the treatment of resistant bilateral upper and lower eyelid ectropion postburn injury. Eplasty 12:18, 2012
Xue CY, Dai HY, Li L, Wang YC, Yang C, Li JH, Xing X: Reconstruction of lower eyelid retraction or ectropion using a paranasal flap. Aesthetic Plast Surg 36(3):611-7, 2012
Zhang Y, Wu HL, Lu YM: Contralateral nasolabial flap for reconstruction of midface defects. Aesthetic Plast Surg 36(5):1175-8, 2012
Ψύλλας ΚΓ: Εισαγωγή στην Οφθαλμολογία και στη Νευροοφθαλμολογία. University Studio Press 1996, σελ. 69-77
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