Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr 19;5(4):e1301.
doi: 10.1097/GOX.0000000000001301. eCollection 2017 Apr.

Eyelid Reconstruction Using Oral Mucosa and Ear Cartilage Strips as Sandwich Grafting

Naoto Yamamoto  1 , Hiroyuki Ogi  1 , Satoshi Yanagibayashi  1 , Ryuichi Yoshida  1 , Megumi Takikawa  1 , Akio Nishijima  1 , Tomoharu Kiyosawa  1
Affiliations

Eyelid Reconstruction Using Oral Mucosa and Ear Cartilage Strips as Sandwich Grafting

Naoto Yamamoto et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: The eyelid structure can be divided into an inner layer and an outer layer. Reconstruction of a full-thickness eyelid defect is accomplished by full-thickness composite tissue transfer or combined layered reconstruction. We present a new technique for inner layer reconstruction using ear cartilage and oral mucosa.

Methods: The oral mucosa graft is harvested from the inner side of the lower lip to fit the defect size and shape. The ear cartilage graft is harvested as a rectangular strip. The harvested mucosa is sutured to the defect margin and the cartilage strip graft is interposed to the defect. Finally, the outer layer of the defect is covered with skin flaps. Consequently, the ear cartilage graft is sandwiched between the mucosa graft and the skin flap.

Results: We used this technique for the reconstruction of 13 full-thickness eyelid defects of various locations, sizes, and shapes. Ten cases involved the lower eyelid, 2 cases involved the lower eyelid including the medial canthus, and 1 case involved the upper eyelid. The oral mucosa graft survived in all patients. The reconstructions were successful and there were no postoperative reports of conjunctival or corneal irritation.

Conclusions: The present technique using a combination of an ear cartilage strip graft and oral mucosa graft is an easy and versatile technique for reconstruction of inner layer eyelid defects. We believe that the beneficial effects of tears, which are richly oxygenated, improved survival of the grafted mucosa.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Diagram of the sandwich technique. Upper: Oral mucosa and ear cartilage grafting procedure for inner layer reconstruction. Lower: Sectional drawing of the reconstructed full-thickness defect.
Fig. 2.
Fig. 2.
Case 1. Basal cell carcinoma arising in the lower eyelid margin and marking of the incision line.
Fig. 3.
Fig. 3.
Case 1. Defect after tumor excision.
Fig. 4.
Fig. 4.
Case 1. Harvesting of the oral mucosa from the lower lip.
Fig. 5.
Fig. 5.
Case 1. Harvesting of the ear cartilage strip though the postauricular incision.
Fig. 6.
Fig. 6.
Case 1. Ear cartilage strip graft (arrow) and mucosal graft.
Fig. 7.
Fig. 7.
Case 1. Inner layer reconstruction was completed and the lateral orbital flap was marked.
Fig. 8.
Fig. 8.
Case 1. Completion of the flap transfer.
Fig. 9.
Fig. 9.
Case 1. One year after surgery.
Fig. 10.
Fig. 10.
Case 1. Reconstructed eyelid margin 1 year after surgery.
Fig. 11.
Fig. 11.
Case 1. View of the donor site of the oral mucosa 6 months after surgery.
Fig. 12.
Fig. 12.
Case 1. View of the donor site of the ear cartilage 6 months after surgery.
Fig. 13.
Fig. 13.
Case 2. Preoperative view.
Fig. 14.
Fig. 14.
Case 2. Defect after tumor resection.
Fig. 15.
Fig. 15.
Case 2. The mucosal graft was sutured at the tissue margin. Arrows indicate the stump of the levator aponeurosis.
Fig. 16.
Fig. 16.
Case 2. Completion of inner layer reconstruction. The ear cartilage strip graft was fixed to the stumps of the inner canthus tendon and the tarsal palate. The levator stump was sutured to the upper edge of the cartilage graft.
Fig. 17.
Fig. 17.
Case 2. The outer layer was reconstructed with a medial forehead flap.
Fig. 18.
Fig. 18.
Case 2. Two years after surgery.
See this image and copyright information in PMC

References

    1. Tyers AG, Collin JRO. Tyers AG, Collin JRO. Eyelid reconstruction: Eyelid margin closure. In: Color Atlas of Ophthalmic Plastic Surgery. 2007:3rd ed Oxford, UK; Butterworth-Heinemann: 349–362..
    1. Tenzel RR. Reconstruction of the central one half of an eyelid. Arch Ophthalmol. 1975;93:125–126.. - PubMed
    1. Yamamoto N, Yanagibayashi S, Yoshida R, et al. 2-Octyl-cyanoacrylate skin adhesive used as a splinting material in auricular surgery. Modern Plastic Surg. 2016;6:21–26..
    1. Mustradé JC. Repair and Reconstruction in the Orbital Region. 19913rd ed Edinburgh: Churchill Livingstone.
    1. Takikawa M, Nambu M, Kato M, et al. Two cases of lower eyelid repair with lateral orbital flap after sebaceous carcinoma resections. Skin Surg. 2007;16:13–17. (written in Japanese).