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

Abstract

Purpose: To use hard palate mucoperiosteum to reconstruct the upper eyelid wisely and to evaluate its function and outcome. Methods: 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. Results: 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%). Conclusions: not only effectively reconstructs the upper eyelid but also provides protection for the cornea.

Posterior lamella substitutes in full-thickness eyelid reconstruction: a narrative review

“…The anatomical structure and biomechanics of hard palatal mucoperiosteum (HPM) are similar to the tarsoconjunctiva with dense collagen fiber structure and density (1,(29)(30)(31). HPM can simultaneously replace the tarsal plate and palpebral conjunctiva.…”

“…After repairing the posterior lamella of the eyelid, HPM also performs as a stent well attaching to the eyeball surface and conforming to the eyeball curvature, which are apparent advantages among various tarsal substitutes, e.g., ear cartilage graft (1). However, applying the HPM to repair upper eyelid defects is controversial because the stratum corneum of the HPM may cause friction against the cornea (29).…”

Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques

“…The HPM grafts have both fibrous connective tissue and a mucosal surface that is histologically similar to the tarsoconjunctiva [ 57 ]. HPM grafts can provide good and lasting structural support to the eyelids, making them an optimal choice for repairing posterior lamellar defects [ 58 , 59 ].…”

How and when of eyelid reconstruction using autologous transplantation

“…Hard-palate mucoperiosteal grafts: Hard-palate mucoperiosteal (HPM) grafts, described for the first time by Siegel[ 25 ] in 1985, can be used to replace the posterior lamella due to the ability of this graft to provide structural support and mucosal lining[ 9 ]. HPM may be considered the optimal choice for reconstructing the posterior lamella of the eyelids because it has similar histological composition and texture to the tarsoconjunctiva, and an adequately sized graft can easily be acquired[ 26 , 27 ]. HPM tends to be one of the preferred choices for most lower eyelid reconstructions in routine clinical settings[ 26 ].…”

“…HPM may be considered the optimal choice for reconstructing the posterior lamella of the eyelids because it has similar histological composition and texture to the tarsoconjunctiva, and an adequately sized graft can easily be acquired[ 26 , 27 ]. HPM tends to be one of the preferred choices for most lower eyelid reconstructions in routine clinical settings[ 26 ]. The use of HPM in upper eyelid reconstruction is controversial because hard-palate mucosa is composed of keratinized, stratified squamous epithelium, which can irritate the cornea, especially when the defect is adjacent to the middle part of the cornea[ 9 , 28 ].…”