The lower-eyelid tarsal-strip procedure.Facial paralysis affecting the orbicularis oculi can result in a loss of blink, an inability to achieve full eye closure, and lower-lid laxity laxity /lax·i·ty/ (lak´si-te) 1. slackness or looseness; a lack of tautness, firmness, or rigidity. 2. slackness or displacement in the motion of a joint.lax´ laxity looseness. . Subsequent catastrophic ophthalmologic complications, such as exposure keratitis and corneal ulceration, may occur if the periocular aspects of the paralysis are left untreated. An upper-eyelid gold-weight implant can help produce a gravity-dependent blink, but the eye may not close completely because of lower-lid canthal laxity. The tarsal-strip procedure is designed to correct lid laxity by shortening the lower canthus canthus /can·thus/ (kan´thus) pl. can´thi [L.] the angle at either end of the fissure between the eyelids, lateral or medial. can·thus n. pl. and suspending it from the medial surface of the lateral orbital rim. The first step is to mark a 1-cm incision along a natural wrinkle line in the lateral canthal area. The marked area is infiltrated with 1% lidocaine lidocaine /li·do·caine/ (li´do-kan) an anesthetic with sedative, analgesic, and cardiac depressant properties, applied topically in the form of the base or hydrochloride salt as a local anesthetic; also used in the latter form as a in 1:100,000 epinephrine. Sharp scissors scissors Cutting instrument or tool consisting of a pair of opposed metal blades that meet and cut when the handles at their ends are brought together. Modern scissors are of two types: the more usual pivoted blades have a rivet or screw connection between the cutting ends are used to cut through the orbicularis oculi all the way down to the lateral orbital rim. The anterior lamellar lamellar /la·mel·lar/ (lah-mel´ar) 1. pertaining to or resembling lamellae. 2. lamellated (1). lamellar pertaining to or emanating from lamella. flap (skin and muscle) is dissected inferiorly and off the lateral aspect of the inferior canthal tendon (figure 1, A). Next, the conjunctiva is dissected from the inferior canthal tendon, and an inferior cantholysis is performed. The lower canthal tendon is stretched to the orbital rim so that the surgeon can estimate the amount of shortening required for proper lid tension (figure 1, B). The gray line is removed, and the flap of excess skin and muscle is trimmed. The lower canthal tendon is then suspended to the periosteum periosteum Dense membrane over bones. The outer layer contains nerve fibres and many blood vessels, which supply cells in the bone. The bone-producing cells of the inner layer are most prominent in fetal life and early childhood, when bone formation is at its peak. over Whitnall's tubercle tubercle (t  `bərkyl') [Lat.,=little swelling], small, usually solid, nodule or prominence. with a 4-0 polydioxanone or 4-0
Mersilene suture (figure 1, C). The skin of the lateral canthus is then
reapproximated with a running 6-0 fast-absorbing gut suture.
[FIGURE 1 OMITTED] In the case illustrated in this article, the final cosmetic results are good (figure 2). [FIGURE 2 OMITTED] Dana S. Smith, MD; Mark K. Wax, MD From the Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland. |
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