Aesthetic and Functional Outcomes of Upper Blepharoplasty Combined with Dacryoadenopexy in Lacrimal Gland Prolapse

Ana Pupić-Bakrač; Josip Knežević; Jure Pupić-Bakrač; Ivan Škegro; Josip Pavan; Anđela Jukić; Mario Rašić; Tomislav Jukić

doi:10.1007/s00266-024-03972-9

Aesthetic and Functional Outcomes of Upper Blepharoplasty Combined with Dacryoadenopexy in Lacrimal Gland Prolapse

Aesthetic Plast Surg. 2024 Apr 2. doi: 10.1007/s00266-024-03972-9. Online ahead of print.

Authors

Ana Pupić-Bakrač¹, Josip Knežević², Jure Pupić-Bakrač³, Ivan Škegro², Josip Pavan⁴, Anđela Jukić⁴, Mario Rašić⁵, Tomislav Jukić²

Affiliations

¹ Department of Ophthalmology, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia. anapupicbakrac@gmail.com.
² Department of Ophthalmology, University Hospital Centre Zagreb, Kišpatićeva ul. 12, 10000, Zagreb, Croatia.
³ Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Bože Peričića 5, 23000, Zadar, Croatia.
⁴ Department of Ophthalmology, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia.
⁵ Department of Otorhinolaryngology and Maxillofacial Surgery, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre, Ilica 197, 10000, Zagreb, Croatia.

PMID: 38565726
DOI: 10.1007/s00266-024-03972-9

Abstract

Introduction: Lacrimal gland prolapse (LGP) is a term used to describe a benign, anterior displacement of the lacrimal gland. If this condition is not properly addressed during upper blepharoplasty, the aesthetic and functional results are less than optimal. This study aimed to report the surgical outcomes of upper blepharoplasty combined with dacryoadenopexy in patients with LGP.

Methods: We reported an unusual case of severe LGP in a young patient. In addition, we performed a systematic review of the English literature on surgical cases of LGP published between 1973 and 2023. Eligible articles were analyzed for individual patient data (IPD) and aggregate patient data (APD). The primary predictor variable was the surgical technique used for lacrimal gland repositioning/suspension. The primary outcome variable was relapse rate.

Results: The bibliographic search retrieved 488 surgical cases of LGP: 12 in IPD, and 476 in APD datasets. The relapse rates in the IPD and APD cohorts were 8.3% (1/12) and 1.2% (6/476), respectively. Within the APD dataset, no significant difference in the relapse rates between dacryoadenopexy via suture suspension and Whitnall's ligament suspension (5/409 and 1/20, respectively; P > 0.05) was observed. Light cauterization of the lacrimal gland capsule and surrounding soft tissues was performed in mild LGP cases (< 4 mm prolapse), with a relapse rate of 0% (0/47).

Conclusion: Upper blepharoplasty combined with dacryoadenopexy proved to be a safe surgical procedure with very satisfactory aesthetic outcome and minimal relapse rate.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Dacryoadenopexy; Herniation; Lacrimal gland; Prolapse; Upper blepharoplasty.