Correction of Traumatic Upper Lid Deformity

Lee, Keun Cheol; Kim, Min Su; Kwon, Yong Seok; Cha, Byung Hoon; Kim, Seok Kwun

Abstract

The most common type of emergency treatment in the field of plastic and reconstructive surgery is for facial soft tissue injuries. Especially upper lid injury cases can easily be treated by primary closure. However, primary closure of lid results vary from just scar formation to loss of double fold and ptosis. Having successfully performed correction of the traumatic upper lid deformity by various methods with satisfactory results, we now report these results. We performed correction on 24 patients, who visited our hospital primarily because of traumatic upper lid deformity. They had diverse main symptoms, including the loss of double fold, asymmetric eyelid, ectropion and ptosis after trauma. The surgical method was removal of previous scar tissues to prevent deformity by adhesion, followed by complete release of adhesive tissues around aponeurosis. If there was ptosis or loss of double fold, we fixed the cut levator aponeurosis to the tarsal plate, or fixed the posterior surface of the orbital septum or levator aponeurosis to the dermal plane of the lower line of skin incision or superior tarsal border. In cases of ectropion or lagophthalmos, adhesive scars were sufficiently detached from levator aponeurosis to enable eye closure. All patients showed improvement of previous deformities and there was no relapse or any newly developed deformities by adhesive scars. As traumatic upper lid noticeable deformities usually have excessive adhesion of scars and distortion of normal anatomical structures, preoperative evaluation with careful and accurate techniques suitable for each cause, are thought to be essential for obtaining good results.