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Impressum
Plastic surgery of congenital lid anomalies
Tost F., Cordes A. K., Clemens S.
Augenklinik, Ernst-Moritz-Arndt-Universität, Rubenow-Str. 2, D-17487 Greifswald
Background: Treatment of congenital lidanomalies has to consider
particular aspects. Not infrequently, there is an indication for treatment
in young patients with pronounced tissue tension (lower horizontal and
vertical laxity) and diminished mobilization in reserve. Variance of normal
lid structure can jeopardize the operative result. Laser surgery is not
indicated in case of congenital nevocellular nevi because of the danger
of malignant transformation.
Patient and Methods: The surgical replacement of the defect is
the first choice in congenital malformations like colobomas, dermoids
or nevocellular nevi. We present 8 patients with congenital lid anomalies
(1 coloboma, 7 nevocellular nevi) in which we performed a replacement
with free tarsal grafts or an operation described by Wheeler.
Results: The functional - aesthetic results and the patients acceptance
were good. The Wheeler procedure with U-suture to reduce traction in the
wound area proved to be especially successful when anomalies of normal
eyelid structure occurred. A reconstruction of the posterior lamella with
a full thickness free tarsal graft taken from the opposite upper lid lead
to operative success in broad-based nevocellular nevi which were located
near the lid-margin. The wound healing by spontaneous granulation of the
opposite upper lid was without complication in all cases. It is important
to spare the inner lid-margin including an adjacent 4mm strip of intact
tarsus. A careful operating technique avoids the risk of postoperative
ptosis.
Conclusion: Free tarsal grafts are suited best for reconstruction
of small broadbased defects of lid margin. It has a high acceptance in
patients especially because of the invisible gaining area. The adequate
choice of operative procedure is most important for a good functional
- aesthetic result.