Defining the Role of Secondary Intention Healing in Full-Thickness Lid Margin Defects

Morton, Jonathan

doi:10.1097/prs.0000000000002252

Cited by 10 publications

(10 citation statements)

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“…9 When part of the proximal lacrimal system is compromised due to tumour or trauma, there also remains the option of leaving the remnant lacrimal system alone without reconstruction and only reconstructing the lid defect, 10 or leaving the lid defect to heal by secondary intention. 11 Lacrimal system reconstruction following medial canthal tumour resection is not well studied. The majority are case series or a small subset of patients in larger retrospective cohort studies that examine either a specific reconstructive method to the skin and medial canthal area or lacrimal system obstruction due to a variety of causes.…”

Section: What This Study Addsmentioning

confidence: 99%

“…The majority are case series or a small subset of patients in larger retrospective cohort studies that examine either a specific reconstructive method to the skin and medial canthal area or lacrimal system obstruction due to a variety of causes. [10][11][12][13][14][15][16] Marsupialisation of the remnant canaliculus is a relatively straightforward procedure. It can be easily incorporated into the reconstruction of the eyelid following tumour resection.…”

Section: What This Study Addsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Bypassing the canaliculus and lacrimal sac altogether with a conjunctivodacryocystorhinostomy and Lester Jones tube placement remains the gold standard when there is extensive canalicular obstruction, congenital agenesis, failed previous canalicular surgery or functional epiphora 9. When part of the proximal lacrimal system is compromised due to tumour or trauma, there also remains the option of leaving the remnant lacrimal system alone without reconstruction and only reconstructing the lid defect,10 or leaving the lid defect to heal by secondary intention 11…”

Section: Introductionmentioning

confidence: 99%

“…Lacrimal system reconstruction following medial canthal tumour resection is not well studied. The majority are case series or a small subset of patients in larger retrospective cohort studies that examine either a specific reconstructive method to the skin and medial canthal area or lacrimal system obstruction due to a variety of causes 10–16. Marsupialisation of the remnant canaliculus is a relatively straightforward procedure.…”

Section: Introductionmentioning

confidence: 99%

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Holding back the tears: is there a role for marsupialisation?

2022

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ObjectiveMedial eyelid tumours may result in the loss of the proximal lacrimal system during staged excision and delayed reconstruction, to achieve tumour margin clearance. The remnant canaliculus was marsupialised during reconstruction. The aim was to understand how many patients experienced symptomatic epiphora as a consequence of this.Methods and analysisA retrospective study including patients over a 15-year period with medial eyelid tumours, where the proximal lacrimal system was sacrificed to achieve tumour margin clearance. Included were all who had marsupialisation of the remnant distal stump as part of their delayed reconstruction. All who had pre-existing epiphora were excluded. The primary objective was the rate of epiphora following the procedure. A systematic literature review of postoperative epiphora occurring in patients with lid tumours requiring lacrimal system injury/sacrifice during tumour excision.ResultsThere were 22 eyes (22 patients). All were basal cell carcinomas except for 1 (4.5%) tarsal conjunctival squamous cell carcinoma. All cases involved the lower lid. There were two (9.1%) patients who developed epiphora. One patient underwent a superior three-snip punctoplasty, botulinum toxin to the lacrimal gland and conjunctivodacryocystorhinostomy with Lester Jones tube insertion. The other patient was not overly troubled and did not require further treatment. The literature review showed the median postoperative rate of epiphora in these patients was 12.5% (range 0%–100%).ConclusionMarsupialisation of the remnant canaliculus during delayed reconstruction is a straightforward and effective surgical option, which may help prevent postreconstruction epiphora when the proximal lacrimal system is sacrificed for tumour margin clearance.Trial registration number10391.

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Section: What This Study Addsmentioning

confidence: 99%