Printer Friendly

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. 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 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 in 1:100,000 epinephrine. Sharp scissors are used to cut through the orbicularis oculi all the way down to the lateral orbital rim. The anterior lamellar 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 over Whitnall's tubercle 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.


In the case illustrated in this article, the final cosmetic results are good (figure 2).


Dana S. Smith, MD; Mark K. Wax, MD

From the Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland.
COPYRIGHT 2005 Vendome Group LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2005, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
Printer friendly Cite/link Email Feedback
Author:Wax, Mark K.
Publication:Ear, Nose and Throat Journal
Article Type:Brief Article
Date:Nov 1, 2005
Previous Article:Dedifferentiated cervical liposarcoma.
Next Article:Class action lawsuits.

Related Articles
Facial plastic surgery clinic.
Powered instrumentation for facial flap thinning.
The role of the middle fossa approach in the management of traumatic facial paralysis.
Combining multiple surgical techniques for maximum scar camouflage.
Achieving a natural nasal dorsum in rhinoplasty.
Paralytic lagophthalmos: gold-weight implantation.

Terms of use | Privacy policy | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters