Hard Palate Graft Research Articles

Functional Reconstruction of Unilateral, Subtotal, Full-Thickness Upper and Lower Eyelid Defects with a Single Hard Palate Graft Covered with Advancement Orbicularis Myocutaneous Flaps

Functional Reconstruction of Unilateral, Subtotal, Full-Thickness Upper and Lower Eyelid Defects with a Single Hard Palate Graft Covered with Advancement Orbicularis Myocutaneous Flaps

Efficacy of “Thick” Acellular Human Dermis (AlloDerm) for Lower Eyelid Reconstruction

To evaluate the efficacy of thick acellular human dermis (thick AlloDerm [LifeCell Corporation, The Woodlands, Tex]) grafts for posterior and middle lamellae reconstruction to correct lower eyelid retraction and to compare the long-term efficacy of thick AlloDerm with thin AlloDerm and hard palate grafts. Retrospective analysis of patients undergoing lower eyelid reconstruction, which encompassed subperiosteal midface lifting, middle lamellae scar lysis, and placement of lower eyelid thick AlloDerm graft. Analysis included 21 surgical procedures in 11 patients. All patients had undergone at least 1 previous lower eyelid surgery with resultant lower eyelid retraction and scleral show. Preoperative and postoperative photographs were used for analysis. Measurements of the corneal diameter and distance from pupil center to lower eyelid margin were obtained, standardized, and compared. Of 21 procedures, 16 (8 of 11 patients) demonstrated improvement of lower eyelid position. The mean improvement of the median marginal reflex distance was 1.6 mm (range, 0.4-2.2 mm). The average follow-up after surgery was 215 days (range, 3-12 months). Of 21 procedures (3 patients), 5 failed to demonstrate improvement of lower eyelid position, with the mean final eyelid position lower postoperatively by 0.8 mm (range, 0.4-1.4 mm). We demonstrated long-lasting improvement of lower eyelid position with placement of thick AlloDerm grafts during lower eyelid reconstruction. The patients in our study had undergone previous lower eyelid blepharoplasty with resultant middle lamellae tethering. Surgical correction included subperiosteal midface-lift and middle lamellae scar lysis, in addition to thick AlloDerm graft placement to the lower eyelid. The results are comparable to hard palate grafts but perhaps superior to thin AlloDerm grafts.

Unilateral Microblepharon

We report the clinical features and surgical treatment of a 15-year-old girl with unilateral microblepharon. The anomaly was characterized by a vertical shortage of upper and lower eyelid skin, causing nocturnal lagophthalmos, corneal exposure, and cosmetic deformity. Treatment consisted in hard-palate grafting and lateral tarsal strip suspension of the lower eyelid of the affected side. The outcome was considered satisfactory by the surgeon and by the patient. No further surgery was required.

Hard palate mucosal grafts in oculoplastic surgery: donor site lessons

PurposeHard palate mucosal grafts have been used successfully in posterior lamellar reconstruction. Atypical surgical findings, techniques, and complications related to the hard palate donor site are reported herein. DesignInterventional case series. MethodsThe medical records of five patients who were cared for in an institutional practice between 1987 and 2002 were retrospectively reviewed. All patients had unusual donor site findings discovered during or after hard palate mucosal grafting for eyelid or socket reconstruction. ResultsSeven eyelid reconstructions with hard palate grafts were performed on the five patients (three male, two female), with an age range of 14 to 73 years at surgery. Patients were followed for an average of 6 years (range: 9 months to 11 years). Unusual hard palate findings during surgery or the postoperative period included hard palate and maxillary sinus malignancy, torus palatinus, and persistent donor site bleeding that provoked gastric variceal bleeding in a patient with preexisting liver disease. Atypical surgical techniques included both inadvertent and intentional harvesting of hard palate tissue over the midline palatine raphe. ConclusionHard palate grafting is a successful and commonly practiced approach to eyelid and socket reconstruction. An awareness of unusual anatomic findings or techniques associated with the hard palate donor site may improve surgical outcomes and decrease patient morbidity.

Colour Atlas of Ophthalmic Plastic Surgery

Anthony G. Tyers and J. Richard O. Collin Colour Atlas of Ophthalmic Plastic Surgery, 2nd ed.360 pagesButterworth Heinemann, Oxford, 2001.Isbn 0750642548Price: £ 130.00 The first edition of this atlas appeared in 1995. In the second, the authors' have revised the text and added previously omitted procedures and newer techniques like the use of hard palate grafts. Homologous grafts, especially donor sclera, have given rise to great concern (or even become abandoned) in many states. Although still useful, alternative materials are presented in this edition. Introductory chapters cover relevant anatomy, evaluation, anaesthesia, instruments, and basic surgical principles. The 13 following chapters focus on lid surgery; there are also thorough descriptions of enucleation/evisceration and socket reconstruction and a brief chapter on orbital decompression. The authors have selected well documented procedures for the treatment of all frequent and many less often occurring conditions. The text is brief, logical and extremely clear, and there should be little difficulty to follow the course recommended. Colour photographs of superb quality illustrate almost every step of the operations. It is self-evident that the reviewer does not agree with all the authors' opinions. I would sometimes select less elaborate techniques (e.g. for a lateral tarsorrhaphy) and I never use Frost sutures after ptosis surgery, a spacer for upper eyelid retraction, etc. I can neither accept the general recommendation of a dressing after lid surgery. There are minor errors of no practical importance, e.g. the so-called Kuhnt-Szymanowski operation which is not the original one but a late modification. Of somewhat greater importance for the less experienced surgeon is the slightly confusing order of presentation of tumour surgery. Also, I do not think that many of those buying this book would (or should) perform a Mustardé cheek flap. In its place, the Hewes laterally based tarsoconjunctival flap and the tarsomarginal flap of Hübner could have been detailed. This is minor criticism; the surgeon who operates according to the book will do a prime job. When asked to recommend a manual for oculoplastic surgery, I have earlier most often suggested the first edition; the second one is even more recommendable.

The madame butterfly procedure: Management of the unhappy postblepharoplasty patient with lower-eyelid retraction, round eye, and scleral show

The unhappy postblepharoplasty patient with lateral canthal dystopia, round eye, and scleral show presents perhaps the single greatest challenge to the aesthetic reconstructive surgeon. The problem may be as simple as a lax eyelid that is inferiorly displaced by gravity, or as complex as an eyelid that has full-thickness vertical inadequacy in each of the three eyelid lamellae. The Madame Butterfly procedure with hard palate graft reliably addresses full-thickness lower-eyelid vertical tissue inadequacy by totally reconstructing the lower eyelid with the use of the classic three-individual-layer reconstructive technique. Vertical and horizontal adequacy or inadequacy for each of the three eyelid layers are determined and then individually addressed in the total eyelid reconstruction. The Madame Butterfly procedure has the potential to fully reconstruct and reposition the lower eyelid and lateral canthus so that the final position, function, and appearance are as good or better than they were before they were changed by time, gravity, and previous surgery.

Management of Postblepharoplasty Lower Eyelid Retraction with Hard Palate Grafts and Lateral Tarsal Strip

Management of Postblepharoplasty Lower Eyelid Retraction with Hard Palate Grafts and Lateral Tarsal Strip

Hard-Palate Mucosa Graft in Stevens-Johnson Syndrome

We evaluated the use of hard-palate mucosa grafts in the treatment of cicatricial entropion and trichiasis associated with Stevens-Johnson syndrome. Six patients, two men and four women, were treated with hard-palate mucosa grafts of one or more eyelids with cicatricial entropion, trichiasis, and corneal disease. The follow-up ranged from 19 to 33 months. Visual acuity improved in one of nine eyes and remained stable in the rest. Corneal epithelial disease improved in eight of nine eyes, while in one eye the epithelial defect stabilized. The corneal epithelium of all three corneal transplants remained intact, although one of these patients underwent another corneal transplantation and the other two transplants opacified from rejection. Cicatricial entropion resolved and symblephara improved in all 16 eyelids. Trichiasis resolved or improved in 12 of 16 eyelids and remained stable in the other eyelids. The chronic relapsing nature of Stevens-Johnson syndrome requires caution in interpreting surgical intervention in the treatment of dysfunctional eyelids. However, hard-palate grafts may be considered for patients with the Stevens-Johnson syndrome and severe ocular surface disease.

Madame Butterfly Procedure with Hard Palate Graft: Management of Postblepharoplasty Round Eye and Scleral Show

Madame Butterfly Procedure with Hard Palate Graft: Management of Postblepharoplasty Round Eye and Scleral Show

Intraoral palatal mucosal graft harvest.

The anatomy of the hard plate is reviewed with respect to the clinical considerations of harvesting intraoral hard palate grafts for various reconstructive eyelid procedures. Recommendations for harvesting grafts based on these anatomic principles are given.