Correction of Lower Eyelid Retraction with Autogenous Hard Palate Mucosa : 2 Case Report

PURPOSE: Grave's disease is an autoimmune disease with chronic and systemic features. It affects the orbital fat and muscle bringing about defect in extrinsic eye motility, diplopia, optic nerve defect and lid retraction. In patients with lagopthalmos and resulting facial deformity, treatment can be done by rectus muscle recession or filling with various material. Autogenous auricular cartilage graft is often used and synthetic material such as synthetic acellular dermis, polyethylene meshs are also used for filling of the depressed area. Nevertheless, autogenous auricular cartilage grafts are difficult to utilize and synthetic materials sometimes result in protrusion or infection. Therefore, hard palate mucosa was considered as an alternative. We report two cases of patients with lower eyelid retraction corrected with autogenous hard palate mucosa. METHODS: We performed this operation in two patients of Graves' ophthalmopathy. The capsulopalpebral fascia was incised and elevated through an incision on the conjunctiva. Then, the harvested hard palate mucosa was sutured to the inferior border of the tarsus and covered with the conjunctiva. RESULTS: The lower eyelid retraction was corrected successfully. No hypertrophy or deformation of the transplanted hard palate mucosa was noted 6 months after the surgery. CONCLUSIONS: From the results above, we may conclude that the hard palate mucosa serves as an ideal spacer for the curvature and the inner lining in lower lid retraction. Hard palate mucosa is as sturdy as the autogenous cartilage but is much easier to utilize. It can be also used for lid retraction after lower lid aesthetic surgeries or traumas.

Hard Palate Mucosa Grafts for Cicatricial Entropion

Various surgical procedures have been described for correction of cicatricial entropion of the eyelid. Many of them fail to provide long-term correction and anatomic alteration which is the excessive scarring of the posterior lamella of the eyelid. Hard palate mucosa grafts provide a smooth mucosal surface to the cornea and buttress the scarred tissues of the posterior eyelid. Ten eyelids of eight patients underwent eyelid margin reconstruction using hard palate mucosa graft. Cicatricial entropions were secondary to chemical burn(2 patients), herpes zoster (1 patient), atopic dermatitis (1 patient), toxic epidermal necrolysis (1 patient) and Stevens-Johnson syndrome (3 patients). Surgical results in ten eyelids were satisfactory. The grafts contracted minimaIly, and the palatal donor site healing was completed in 2-4 weeks.