Staged Periorbital Reconstruction for Cicatricial Lagophthalmos

Abstract

Eyelid trauma can present reconstructive challenges for facial surgeons. The authors postulated that treating cicatricial lagophthalmos with protective ptosis in the acute setting prior to definitive grafting could help limit scar contraction. This is an observation of a patient who benefited from a staged approach to periorbital reconstruction after suffering extensive facial trauma. Informed consent was appropriately obtained from the patient. After treating the periorbital injury in staged fashion, an aesthetically acceptable result was achieved and was well-tolerated by the patient. Disruption of the periorbital region, particularly the eyelids, can have severe functional and aesthetic consequences. One such disruption is lagophthalmos. Neurotoxin-induced protective ptosis is a well-known strategy that can be used as the initial treatment in a staged approach to cicatricial lagophthalmos. Treating lagophthalmos with protective ptosis in the acute setting prior to definitive grafting is not only a means of avoiding tarsorrhaphy but also it can allow time for the wound to declare itself and limit scar contraction. In addition, the contralateral eyelid represents both a complimentary skin graft harvest site as well as an opportunity to create a symmetrical repair.