Objective: To present the clinical manifestations and outcome of the surgical management of subjects with Tessier number 10 clefts.
Design: Retrospective, interventional case series.
Participants: Twelve patients with Tessier number 10 clefts treated at the Department of Ophthalmology of Shanghai Ninth People's Hospital between January of 2002 and December of 2005.
Methods: All 12 patients (15 eyes) underwent a standard ophthalmologic assessment, and the orbits were examined by a 3-dimensional computed tomography scan. Reconstructive techniques included eyebrow reconstruction with a frontal hairline transposition flap, eyelid reconstruction with a hard palate mucosa-lined sliding myocutaneous flap, and conjunctival fornix reconfiguration using a mucous membrane graft. In patients requiring enucleation, hydroxyapatite implant was used, followed by fitting of ocular prosthesis.
Main outcome measures: Postoperative upper eyelid and eyebrow contour and viability, recurrence of symblepharon, and ability to hold prosthesis.
Results: All reconstructed eyelids achieved the surgical goal of providing corneal coverage and the ability to hold a cosmetic contact lens or an ocular prosthesis. Eyebrow reconstruction was performed in 4 patients. The reconstructed eyebrow was symmetrical with the opposite side. There was no recurrence of symblepharon. Three patients wore cosmetic contact lenses, and their eyelid function appeared adequate. Two patients underwent enucleation along with insertion of a hydroxyapatite implant, followed by fitting of ocular prosthesis.
Conclusions: The surgical approach described in our series of cases seems to be effective in repairing Tessier number 10 clefts. Eyebrow reconstruction with a frontal hairline transposition flap followed by eyelid repair with a hard palate mucosa-lined sliding myocutaneous flap is a suitable technique for correcting eyebrow and eyelid malformations in adults.
Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.