Spacer Graft Combined with Canthal Sling in Paralytic Ectropion

Lower eyelid retraction and ectropion is a result of two factors; (1) weakened intrinsic forces associated with senile change or (2) from extrinsic forces by the augmented distraction activity as a result from scar contracture after surgery, laser therapy, or trauma. Facial nerve palsy, in patients with leprosy, causes paralysis of the orbicularis muscle. Its antagonizing muscles, namely, the levator of the upper lid and the capsulopalpebral fascia of the lower lid, function as normal. This counterbalance results in lagophthalmos and retraction of the eyelids. Conventional surgical methods used to correct the ectropion and retraction of the lower lid include lateral canthoplasty, lateral canthopexy, lateral tarsal strip procedure and medial tarsorrhaphy. Recently the use of spacer graft has been incorporated in treating lower eyelid retraction. The use of spacer grafts creates separation between the tarsal plate and the capsulopalpebral fascia, to introduce materials like palatal mucoperiosteum, conchal cartilage or AlloDerm into the space between the two structures. In this study, we designed as AlloDerm or deep temporal fascia graft to function not only as a spacer graft but also as canthal sling. The use of a long spacer graft-sling to supplement the canthal sling showed superior results in elevating the lower eyelid and reducing ectropion. The use of the spacer graft in this method is more effective than other conventional methods.

Spacer graft combined with canthal sling in paralytic ectropion(Part 2) / 나학회지

The lower eyelid descent and ectropion is resulted from either a decrease in intrinsic forces by senile change or an increase in extrinsic forces by the augmented distraction activity as a result of surgery, laser therapy, or trauma. Although facial nerve palsy in patients with leprosy causes paralysis of the orbicularis muscle, its antagonizing muscles, namely, the levator of the upper lid and the capsulopalpebral fascia of the lower lid, are functioning properly, resulting in lagophthalmos and retraction of the eyelids. There are various conventional surgical methods to correct the ectropion and retraction of the lower lid such as lateral canthoplasty, lateral canthopexy, lateral tarsal strip procedure as well as medial tarsorraphy. Spacer graft, recently introduced, is used to create separation between the tarsal plate and the capsulopalpebral fascia, and to insert maerials like palatal mucoperiosteum, conchal cartilage or Alloderm into the space between the two structures. In this study, we added to one more process to the routine procedure, canthal sling, in which two ends of lengthened Alloderm by 15mm were fixed to both canthal ligaments like a fascial sling. Spacer graft combined with concomitant cnathal sling was proven to be effective in elevating and reducing retraction of the lower lid, and to be superior to any other conventional methods.