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Surgical Pearls |

Single-Stage Repair of Paralytic Ectropion Using a Novel Modification of the Tarsoconjunctival Flap

Ahmed S. Sufyan, MD1; H. B. Harold Lee, MD2; Hassan Shah, MD2; William R. Nunery, MD2; Mimi S. Kokoska, MD1; Taha Z. Shipchandler, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
2Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
JAMA Facial Plast Surg. 2014;16(2):151-152. doi:10.1001/jamafacial.2013.2343.
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Patients with facial paralysis present with a constellation of ocular manifestations. Ectropion resulting from downward displacement of the lower eyelid appears after loss of orbicularis tone and function.1 In addition, upper eyelid retraction, resulting in lagophthalmos and a decrease in tear production and/or proper tear distribution and channeling, may result in dry eyes and epiphora. Tear flow is impaired because of a dysfunctional orbicularis oculi muscle and a decrease in transportation of tears.2

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Figure 1.
Intraoperative Photographs

A, The lateral canthotomy incision has been made. B, A horizontal incision is performed in the lower eyelid tarsus just posterior to the mucocutaneous junction to form a groove for the tarsoconjunctival flap. C, A tarsoconjunctival flap is created by cutting free the upper half of the lateral 4 mm of the upper eyelid tarsus, leaving only conjunctiva attached. D, The tarsoconjunctival flap is dissected down. E, The tarsoconjunctival flap is then secured to the lower eyelid tarsus. F, The lower eyelid tarsus is then reanchored; image shows the final result of the tarsoconjunctival flap. See Figure 2 for artist depiction.

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Figure 2.
Paralytic Ectropion

A, Demonstration of the constellation of symptoms seen in paralytic ectropion. The lateral canthotomy incision is marked. B, A tarsoconjunctival flap is created by cutting free the upper half of the lateral 4 mm of the upper eyelid tarsus, leaving only conjunctiva attached. C, A horizontal incision is performed in the lower eyelid tarsus just posterior to the mucocutaneous junction to form a groove for the tarsoconjunctival flap. D, The tarsoconjunctival flap is dissected down. E, The tarsoconjunctival flap is then secured to the lower eyelid tarsus. F, The lower eyelid tarsus is then reanchored; image shows the final result of the tarsoconjunctival flap.

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