Lower Eyelid Retraction Repair Using Autologous Auricular Scapha Cartilage

Abstract

Abstract Purpose: To evaluate lower eyelid retraction surgery using autologous auricular scapha cartilage (anterior surface groove between helix and anti helix) and present its surgical results in a group of patients. Methods: Medical records of 21 patients who underwent lower eyelid retraction surgery using scapha cartilage were reviewed. Retractions were longstanding (6 months to 20 years), with 1 mm or more inferior scleral show, and due to previous lower eyelid blepharoplasty, facial palsy or congenital retraction. Lateral canthotomy, cantholysis, subtarsal conjunctiva-lower eyelid retractors incision, lower eyelid retractor lysis and suturing of the cartilage graft to the defect area without conjunctival cover, and tighteneing of the lateral canthal corner were performed in all patients. Results: Twenty nine eyelids in 21 patients were operated. There were no per-operative complications. During the follow-up period (mean 11 months; range 6-30 months), lower lid retraction improved in 96,5% of eyelids. The mean postoperative margin to refle distance measurements (MRD2) was statistically significantly lower compared with preoperatives (p=0,001; p<0,01). Average MRD2-a (midpupil to lower lid) and MRD2-b (lateral limbus to lower lid) improvements were 1,77±0,80 and 2,04±0,81 respectively (p=0,001; p<0,01). Four eyelids (4/29) were revised because of canthal corner loosening. All four already had two or more repairs elsewhere and require correction with periosteal flaps. The graft was visible in two lids but revision was not required. One patient had mild donor area helix deformity that did not require futher intervention. Conclusion: Many lower lid retractions that have no middle or posterior lamellar shortening can be corrected without grafting. However in those cases of lower lid retraction associated with middle/posterior lamella shortening, auricular scapha cartilage spacer graft is useful. Its advantages include ease of harvest with low complication rate at the donor site; being autologous, it is stable and does not shrink; it is softer compared to posterior cartilage and has a concavity that fits well on the globe.