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Facial Plast Surg 2014; 30(06): 656-660
DOI: 10.1055/s-0034-1396525
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Functional Reconstruction of Large Medial Canthal Defects

Adam M. Parker
1   Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi
,
Matthew A. Richardson
1   Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi
,
J. Randall Jordan
1   Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi
› Author Affiliations
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Publication History

Publication Date:
23 December 2014 (online)

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Abstract

The aim of this study is to describe a surgical technique for the reconstruction of large medial canthal defects involving the lacrimal apparatus following excision of medial canthal tumors. Many different techniques for constructing a neopassage from the lacrimal sac to the nasal sinuses have been investigated and described in the literature. However, there continues to be difficulty with successful functional reconstruction of the lacrimal outflow tract without the long-term use of an indwelling tube. We herein describe a technique utilizing a paramedian forehead flap combined with AlloDerm (LifeCell Corporation, Township of Branchburg, NJ) as the conduit for reconstruction of the medial canthus and lacrimal outflow tract. We present a case series of three patients successfully reconstructed with the above technique and describe their presentation, treatment, and postoperative course. We provide a detailed description of the surgical technique and document the success of the technique in regard to patency and postprocedure function of the lacrimal conduit.

Keywords

medial canthal defect - lacrimal apparatus - epiphora - paramedian forehead flap - AlloDerm
 

  • References

  • 1 Tan O. An algorythmic approach to restoration of the fronto-naso-periorbital skin defects using the forehead flaps. J Craniomaxillofac Surg 2010; 38 (1) 11-18
    CrossrefPubMedGoogle Scholar
  • 2 Mutaf M, Günal E. A new alternative for reconstruction of the inferior medial canthal and nasal sidewall defects. J Craniofac Surg 2011; 22 (5) 1793-1795
    CrossrefPubMedGoogle Scholar
  • 3 Lesavoy MA, Kohan E. Total upper and lower eyelid reconstruction using an expanded forehead flap. Ann Plast Surg 2011; 67 (5) 502-504
    CrossrefPubMedGoogle Scholar
  • 4 Rose GE, Verity DH. Lacrimal reconstruction after removal of eyelid or periocular cutaneous cancer. Int Ophthalmol Clin 2009; 49 (4) 207-222
    CrossrefPubMedGoogle Scholar
  • 5 Burget GC, Walton RL. Optimal use of microvascular free flaps, cartilage grafts, and a paramedian forehead flap for aesthetic reconstruction of the nose and adjacent facial units. Plast Reconstr Surg 2007; 120 (5) 1171-1207 , discussion 1208–1216
    CrossrefPubMedGoogle Scholar
  • 6 Burget GC, Murrel GL, Toriumi DM. Aesthetic reconstruction of the confluence of the nose, lip, and cheek. Oper Tech Plast Reconstr Surg 1998; 5 (1) 76-88
    CrossrefPubMedGoogle Scholar
  • 7 Baker SR. Regional flaps in facial reconstruction. Otolaryngol Clin North Am 1990; 23 (5) 925-946
    PubMedGoogle Scholar
  • 8 Price DL, Sherris DA, Bartley GB, Garrity JA. Forehead flap periorbital reconstruction. Arch Facial Plast Surg 2004; 6 (4) 222-227
    CrossrefPubMedGoogle Scholar
  • 9 Athanasiov PA, Madge S, Kakizaki H, Selva D. A review of bypass tubes for proximal lacrimal drainage obstruction. Surv Ophthalmol 2011; 56 (3) 252-266
    CrossrefPubMedGoogle Scholar
  • 10 Sakai S, Soeda S, Matsukawa A. Refinements of the island median forehead flap for reconstruction of the medial canthal area. J Dermatol Surg Oncol 1989; 15 (5) 524-530
    CrossrefPubMedGoogle Scholar
  • 11 Dortzbach RK, Hawes MJ. Midline forehead flap in reconstructive procedures of the eyelids and exenterated socket. Ophthalmic Surg 1981; 12 (4) 257-268
    Google Scholar