Download PDF
Facial Plast Surg 2017; 33(06): 598-605
DOI: 10.1055/s-0037-1608711
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Repair of the Malpositioned Lower Lid

David Chan
1   Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Mofiyinfolu Sokoya
2   Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
,
Yadranko Ducic
3   Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
01 December 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Complications from surgical approaches to the orbit can be associated with debilitating morbidity and negative surgical outcomes. The surgeon must be familiar with the different factors that predispose a patient to these complications and be facile with techniques to avoid them. In this article, the authors discuss the surgical anatomy of the lower eyelid, as well as various complications that result from eyelid surgery, including lower lid retraction, ectropion, entropion, canthal malposition, and midface descent. They also discuss various management techniques that are employed in addressing these complications.

Keywords

lower lid malposition - ectropion - entropion
 

  • References

  • 1 Brown R, Lozada K, Kadakia S, Gordin E, Ducic Y. Prophylactic midface lift in midfacial trauma. Facial Plast Surg 2017; 33 (03) 347-351
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 De Riu G, Meloni SM, Gobbi R, Soma D, Baj A, Tullio A. Subciliary versus swinging eyelid approach to the orbital floor. J Craniomaxillofac Surg 2008; 36 (08) 439-442
    CrossrefPubMedGoogle Scholar
  • 3 Kothari NA, Avashia YJ, Lemelman BT, Mir HS, Thaller SR. Incisions for orbital floor exploration. J Craniofac Surg 2012; 23 (07) (Suppl. 01) 1985-1989
    PubMedGoogle Scholar
  • 4 Raschke GF, Rieger UM, Bader RD. , et al. The zygomaticomaxillary complex fracture—an anthropometric appraisal of surgical outcomes. J Craniomaxillofac Surg 2013; 41 (04) 331-337
    CrossrefPubMedGoogle Scholar
  • 5 Ridgway EB, Chen C, Colakoglu S, Gautam S, Lee BT. The incidence of lower eyelid malposition after facial fracture repair: a retrospective study and meta-analysis comparing subtarsal, subciliary, and transconjunctival incisions. Plast Reconstr Surg 2009; 124 (05) 1578-1586
    CrossrefPubMedGoogle Scholar
  • 6 Yamashita M, Kishibe M, Shimada K. Incidence of lower eyelid complications after a transconjunctival approach: influence of repeated incisions. J Craniofac Surg 2014; 25 (04) 1183-1186
    CrossrefPubMedGoogle Scholar
  • 7 Aldekhayel S, Aljaaly H, Fouda-Neel O, Shararah AW, Zaid WS, Gilardino M. Evolving trends in the management of orbital floor fractures. J Craniofac Surg 2014; 25 (01) 258-261
    CrossrefPubMedGoogle Scholar
  • 8 Raschke GF, Rieger UM, Bader RD, Schaefer O, Guentsch A, Schultze-Mosgau S. Transconjunctival versus subciliary approach for orbital fracture repair—an anthropometric evaluation of 221 cases. Clin Oral Investig 2013; 17 (03) 933-942
    CrossrefPubMedGoogle Scholar
  • 9 Sand JP, Zhu BZ, Desai SC. Surgical anatomy of the eyelids. Facial Plast Surg Clin North Am 2016; 24 (02) 89-95
    CrossrefPubMedGoogle Scholar
  • 10 Shorr N, Fallor MK. “Madame Butterfly” procedure: combined cheek and lateral canthal suspension procedure for post-blepharoplasty, “round eye,” and lower eyelid retraction. Ophthal Plast Reconstr Surg 1985; 1 (04) 229-35
    CrossrefPubMedGoogle Scholar
  • 11 Kakizaki H, Malhotra R, Madge SN, Selva D. Lower eyelid anatomy: an update. Ann Plast Surg 2009; 63 (03) 344-351
    CrossrefPubMedGoogle Scholar
  • 12 Mowlavi A, Neumeister MW, Wilhelmi BJ. Lower blepharoplasty using bony anatomical landmarks to identify and avoid injury to the inferior oblique muscle. Plast Reconstr Surg 2002; 110 (05) 1318-1322 ; discussion 1323–1324
    CrossrefPubMedGoogle Scholar
  • 13 Patel MP, Shapiro MD, Spinelli HM. Combined hard palate spacer graft, midface suspension, and lateral canthoplasty for lower eyelid retraction: a tripartite approach. Plast Reconstr Surg 2005; 115 (07) 2105-2114 ; discussion 2115–2117
    CrossrefPubMedGoogle Scholar
  • 14 Patipa M. The evaluation and management of lower eyelid retraction following cosmetic surgery. Plast Reconstr Surg 2000; 106 (02) 438-453 ; discussion 454–459
    CrossrefPubMedGoogle Scholar
  • 15 Hachach-Haram N, Kirkpatrick WN. Midface-lifting: evolution, indications, and technique. Facial Plast Surg 2013; 29 (04) 289-294
    PubMedGoogle Scholar
  • 16 Hahn S, Desai SC. Lower lid malposition: causes and correction. Facial Plast Surg Clin North Am 2016; 24 (02) 163-171
    CrossrefPubMedGoogle Scholar
  • 17 Jones ST, Aakalu VK, Lin AY. , et al. Surgical microanatomy of lower eyelid tarsal ectropion repair with a Putterman ptosis clamp. Ophthal Plast Reconstr Surg 2017; 33 (04) 261-263
    CrossrefPubMedGoogle Scholar
  • 18 Anderson RL, Gordy DD. The tarsal strip procedure. Arch Ophthalmol 1979; 97 (11) 2192-2196
    CrossrefPubMedGoogle Scholar
  • 19 Fagien S. Algorithm for canthoplasty: the lateral retinacular suspension—a simplified suture canthopexy. Plast Reconstr Surg 1999; 103 (07) 2042-2053 ; discussion 2054–2058
    CrossrefPubMedGoogle Scholar
  • 20 Jelks GW, Glat PM, Jelks EB, Longaker MT. The inferior retinacular lateral canthoplasty: a new technique. Plast Reconstr Surg 1997; 100 (05) 1262-1270 ; discussion 1271–1275
    CrossrefPubMedGoogle Scholar
  • 21 Lisman RD, Campbell J. Tarsal suspension canthoplasty. Aesthet Surg J 1999; 19: 412-423
    CrossrefPubMedGoogle Scholar
  • 22 Nowinski TS, Anderson RL. The medial spindle procedure for involutional medial ectropion. Arch Ophthalmol 1985; 103 (11) 1750-1753
    CrossrefPubMedGoogle Scholar
  • 23 Singa RM, Aakalu VK, Putterman AM, Epstein GA. Lower-eyelid tarsal ectropion repair with the Putterman ptosis clamp for lower-eyelid conjunctival Mueller's muscle resection and lateral tendon tuck. Ophthal Plast Reconstr Surg 2012; 28 (03) 224-227
    CrossrefPubMedGoogle Scholar
  • 24 Bashour M, Harvey J. Causes of involutional ectropion and entropion—age-related tarsal changes are the key. Ophthal Plast Reconstr Surg 2000; 16 (02) 131-141
    CrossrefPubMedGoogle Scholar
  • 25 Spinelli HM, Tabatabai N, Nunn DR. Correction of involutional entropion with suborbicularis septal and lateral canthal tightening. Plast Reconstr Surg 2006; 117 (05) 1560-1567 ; discussion 1568–1570
    CrossrefPubMedGoogle Scholar
  • 26 Steel DH, Hoh HB, Harrad RA, Collins CR. Botulinum toxin for the temporary treatment of involutional lower lid entropion: a clinical and morphological study. Eye (Lond) 1997; 11 (Pt 4): 472-475
    CrossrefPubMedGoogle Scholar
  • 27 Dunnington JH, Regan EF. Ziegler cautery puncture for noncicatricial entropion. Am J Ophthalmol 1966; 61 (5 Pt 2): 1090-1092
    CrossrefPubMedGoogle Scholar
  • 28 Saunders DH, Shannon GM, Nicolitz E. The “corncrib” repair of senile entropion. Ophthalmic Surg 1980; 11 (02) 128-130
    PubMedGoogle Scholar
  • 29 Hill JC, Feldman F. Tissue barrier modifications of a Wheeler II operation for entropion. Arch Ophthalmol 1967; 78 (05) 621-623
    CrossrefPubMedGoogle Scholar
  • 30 Corin S, Veloudios A, Harvey JT. A modification of the lateral tarsal strip procedure with resection of orbicularis muscle for entropion repair. Ophthalmic Surg 1991; 22 (10) 606-608
    PubMedGoogle Scholar
  • 31 Wheeler JM. Spastic entropion correction by orbicularis transplantation. Trans Am Ophthalmol Soc 1938; 36: 157-162
    PubMedGoogle Scholar
  • 32 Nowinski TS. Orbicularis oculi muscle extirpation in a combined procedure for involutional entropion. Ophthalmology 1991; 98 (08) 1250-1256
    CrossrefPubMedGoogle Scholar
  • 33 Rougraff PM, Tse DT, Johnson TE, Feuer W. Involutional entropion repair with fornix sutures and lateral tarsal strip procedure. Ophthal Plast Reconstr Surg 2001; 17 (04) 281-287
    CrossrefPubMedGoogle Scholar
  • 34 Barnes JA, Bunce C, Olver JM. Simple effective surgery for involutional entropion suitable for the general ophthalmologist. Ophthalmology 2006; 113 (01) 92-96
    CrossrefPubMedGoogle Scholar
  • 35 Bartley GB, Kay PP. Posterior lamellar eyelid reconstruction with a hard palate mucosal graft. Am J Ophthalmol 1989; 107 (06) 609-612
    CrossrefPubMedGoogle Scholar
  • 36 Baylis HI, Hamako C. Tarsal grafting for correction of cicatricial entropion. Ophthalmic Surg 1979; 10 (07) 42-48
    PubMedGoogle Scholar
  • 37 Millman AL, Katzen LB, Putterman AM. Cicatricial entropion: an analysis of its treatment with transverse blepharotomy and marginal rotation. Ophthalmic Surg 1989; 20 (08) 575-579
    PubMedGoogle Scholar
  • 38 Sodhi PK, Yadava U, Mehta DK. Efficacy of lamellar division for correcting cicatricial lid entropion and its associated features unrectified by the tarsal fracture technique. Orbit 2002; 21 (01) 9-17
    CrossrefPubMedGoogle Scholar
  • 39 Wojno TH. Lid splitting with lash resection for cicatricial entropion and trichiasis. Ophthal Plast Reconstr Surg 1992; 8 (04) 287-289
    CrossrefPubMedGoogle Scholar
  • 40 DeFatta R, Ducic Y. . Midface lifts. Oper Tech Otolaryngol—Head Neck Surg 2007; 18 (03) 217-232
    PubMed
  • 41 Anderson RD, Lo MW. Endoscopic malar/midface suspension procedure. Plast Reconstr Surg 1998; 102 (06) 2196-2208
    CrossrefPubMedGoogle Scholar
  • 42 Marshak H, Morrow DM, Dresner SC. Small incision preperiosteal midface lift for correction of lower eyelid retraction. Ophthal Plast Reconstr Surg 2010; 26 (03) 176-181
    CrossrefPubMedGoogle Scholar
  • 43 Hinderer UT. Vertical preperiosteal rejuvenation of the frame of the eyelids and midface. Plast Reconstr Surg 1999; 104 (05) 1482-1499 ; discussion 1500–1501
    CrossrefPubMedGoogle Scholar
  • 44 Salgarelli AC, Bellini P, Landini B, Multinu A, Consolo U. A comparative study of different approaches in the treatment of orbital trauma: an experience based on 274 cases. Oral Maxillofac Surg 2010; 14 (01) 23-27
    CrossrefPubMedGoogle Scholar
  • 45 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 2009; 47 (04) 298-301
    CrossrefPubMedGoogle Scholar
  • 46 Elner VM, Demirci H, Morton AD, Elner SG, Hassan AS. Transcaruncular medial canthal ligament plication for repair of lower eyelid malposition. Arch Ophthalmol 2007; 125 (03) 374-379
    CrossrefPubMedGoogle Scholar
  • 47 Jordan DR, Anderson RL, Thiese SM. The medial tarsal strip. Arch Ophthalmol 1990; 108 (01) 120-124
    CrossrefPubMedGoogle Scholar