Three-Dimensional Tarsal Plate Reconstruction Using Lower Lateral Cartilage of the Nose.

Abstract

Many types of graft tissue have been used to reconstruct the posterior lamella of the eyelids in cases of full-thickness defect, lid retraction, and loss of lower lid stability. In this study, lower lateral cartilage of the nose was used for the reconstruction of posterior lamella of the eyelids, which mimics the tarsal plate in shape, thickness, and size. This study included 10 patients who underwent lid reconstruction to support tarsal plate strength and repair full-thickness defects of the eyelids due to tumor excision and trauma. While anterior lamella was reconstructed with local or regional flaps, posterior lamella was repaired by using either chondromucosal or chondral graft of the lower lateral cartilage of the nose. Graft harvesting was performed on the inner surface of the alar rim by turning it inside out. Cartilage grafts were sufficient to reconstruct the tarsal plate in all of the patients having eyelid defects of various sizes. In 3 patients, horizontal half of the eyelid was defective, in 3 patients 3/4, and in 2 patients 4/5 of the lids were missing. The inferior eyelid was totally reconstructed in 1 patient. Surgical outcomes provided good lid symmetry and esthetics, patient satisfaction, and proper lid function without any nasal deformity, incision scar, or discomfort. Ala graft provides a thin, pliable, and curved cartilage for the eyelid reconstruction. It has a high similarity with the anatomy of the tarsal plate, making it adaptable to the convex surface of the eyeball, and making 3 dimensional repair possible.