Buccal mucosal membrane graft for correction of cicatricial lower eyelid retraction

Abstract

Background To evaluate the outcomes of a surgical technique using buccal mucosal membrane graft for correction of cicatricial lower eyelid retraction. Methods Twelve patients with unilateral cicatricial lower eyelid retraction were enrolled in the study. All patients underwent a four-step surgical technique consisted of release of scars, midface lift, transfer of buccal mucosal membrane to posterior lamella as spacer graft, and canthal tightening. All patients were followed for at least 12 months. Results Mean preoperative Margin-to-Reflex-Distance 2 (MRD2) was 7.73 ± 1.10 mm, compared to mean postoperative MRD2 of 5.04 ± 0.49 mm (P < 0.0001). The mean improvement in retraction was 2.69 mm. Postoperative scleral show was present in only one case and no major complications were observed. Conclusion The four-step procedure (scar release, midface lift, buccal mucosal graft and canthal tightening) was an effective procedure to correct cicatricial lower eyelid retractions with acceptable outcomes and a low morbidity rate.

Correction of Cicatricial Lower Eyelid Retraction and Entropion With Combined Scar Release, Hard Palate Graft, and Lateral Canthal Suspension

“…The literature reported that a variety of grafts could be used as spacers for posterior lamellae in the lower lid, and it is proposed that grafts can be divided into 4 groups: autografts, allografts, xenografts, and synthetic grafts, including the hard palate, tarsal bone, nasal septal cartilage, human cadaver acellular dermis, acellular porcine-derived membrane, and high-density polyethylene 8–16 . The decision in the selection of the best graft is associated with its long-term stability, complications at recipient and donor sites, and cosmesis.…”

“…Multiple surgical techniques have been reported successively, from the relatively simple surgical approaches, such as tarsotomy and release of scar limiting upward mobilization of the lid, to more complex procedures, such as lengthening of the middle and posterior lamellas, using spacer grafts 5–7 . Graft materials may include hard palate, buccal mucosa, donor sclera, ear cartilage, nasal cartilage, alloplastic materials, and acellular porcine dermis 8–15 …”