Management of the paralyzed ectropion by implanting the Alloderm(R)

Ahn, Sung Yul; Park, Hyang Joon; Kim, Jong Pill

Abstract

Paralytic lagophthalmos and ectropion in leprosy are serious complications of facial paralysis, which may lead to expose keratitis, corneal ulceration, further lead to blindness. In 1995, 1997 and 1999, we had reported in this journal on the surgical treatment of paralytic lagophthalmos and ectropion. In the first report of 1995 for lid closing, I(Ahn) performed various method of traditional surgery such as temporal muscle transfer, medial and lateral canthoplasty as well as gold implantation. In the 2nd report of 1997, We(Ahn and Park) presented combination treatment of gold plate with minor change of design and weight in the upper lid and medial canthoplasty with horizontal shortening in the lower lid. In the 3rd report of 1999, We described an additional graft of conchal cartilage in the lower lid. However, the lateral end of the cartilage would warp and create new partial ectropion several months later. Therfore, we shifted from cartilage to Alloderm(R), acellular dermal graft. We applied it to the lower border of the tarsus instead of cartilage and fixed each end to medial and lateral canthal ligaments respectively. We think Alloderm(R) is a good substitute for the cartilage and is an effective volume expander to the atrophic lower lid.