Hard Palate Mucoperiosteal Transplantation for Defects of the Upper Eyelid: A Pilot Study and Evaluation.

Abstract

To use hard palate mucoperiosteum to reconstruct the upper eyelid wisely and to evaluate its function and outcome. In this case series, medial or lateral defects of the upper eyelid were reconstructed with a hard palate mucoperiosteum graft and a bandage contact lens to protect the cornea. Slit-lamp examinations, in vivo confocal microscopy, patient surveys, and pathologic examinations were performed as evaluations. Seven patients were included in this study. The average follow-up time was 21.9 months. Postoperatively, all patients maintained their preoperative corneal transparency, and the best-corrected visual acuities remained stable. Postoperative corneal examination by in vivo confocal microscopy was similar to the normal contralateral eye in all cases. All hard palate mucoperiosteal grafts merged smoothly with the normal tarsoconjunctiva. The mean ratio of the graft length to the upper eyelid decreased from 48.6% during the operation to 32.2% during the follow-up; the average shrinkage rate was 16.3% ± 7.1%. Both in vivo confocal microscopy and the pathologic examinations showed that stratified squamous epithelium comprised the main part of the hard palate graft. All patients could blink normally and had a relatively normal appearance. All patients were satisfied with the overall outcome of this therapy. Main complications included loss of eyelashes (100%), abnormal curvature of the eyelid (28.5%), mild lagophthalmos (14.3%), trichiasis (14.3%), and slight exfoliation of the corneal epithelium (42.8%). not only effectively reconstructs the upper eyelid but also provides protection for the cornea.