J Korean Ophthalmol Soc.  2008 Jun;49(6):878-885. 10.3341/jkos.2008.49.6.878.

The Effect of Autologous Dermis-fixation to Orbital Periosteum in Superior Sulcus Deformity

• Kim KH
• Lee TS
• Hwang SJ

• KMID: 2110866
• DOI: http://doi.org/10.3341/jkos.2008.49.6.878

Abstract

PURPOSE: To evaluate the efficacy of autologus dermis-fixation on the orbital periosteum in patients with superior sulcus deformity.
METHODS
From September 2005 to February 2007, an appropriate amount of a rolled autologus dermis was added to the site of superior sulcus deformity by means of fixation to the orbital periosteum via lid crease incision. Four patients had superior sulcus deformity after undergoing evisceration or other ocular surgeries.
RESULTS
Superior sulcus deformities in all patients could be corrected satisfactorily with bilateral symmetry. During the follow-up period, no complications such as mechanical ptosis and recurrence of superior sulcus deformity were observed.
CONCLUSIONS
The authors believe that autologus dermis-fixation to the orbital periosteum might be a useful method to correct superior sulcus deformity without disturbing movement of the upper eyelid. A study with a larger series of patients and longer follow-up period might be necessary in the future to obtain more information about autologous dermis-fixation to the periosteum in patients with superior sulcus deformity.

Keyword

Autologus dermis graft; Periosteal fixation; Superior sulcus deformity

MeSH Terms

Congenital Abnormalities
Dermis
Eyelids
Follow-Up Studies
Humans
Orbit
Periosteum
Recurrence

Figure

• 

  Figure 1. Photographs of operating procedure; (A) Skin incision was made on the lid crease line (or 2 mm above the lid margin); (B) Periosteum of the superior orbital rim was exposed by blunt dissection through the suborbicularis oculi plane without disturbing the septum; (C) Dermis was excised from the greater trochanter and donor site was closed by primary suture;(D) Epithelium was removed by microdrill in harvested dermis; (C) Harvested dermis graft was prepared in a rolled fashion and tied 4 times using 4-0 Prolene; (D) Graft was secured to the periosteum of the superior orbital rim using 4-0 Prolene.

• 

  Figure 2. Photographs showing superior sulcus deformity in the patient 1. (A, B) Before surgery, deep superior sulcus deformity was noted in his right upper lid. (C, D) After dermis-periorbital fixation, superior sulcus deformity was corrected.

• 

  Figure 3. Photographs showing superior sulcus deformity in the patient 2; (A, B) Before surgery, deep superior sulcus deformity was noted in the right upper lid; (C, D) After dermis-periorbital fixation, superior sulcus deformity was corrected.

• 

  Figure 4. Illustration of autologus dermis‐ periosteal fixation to the superior orbital rim; (A) Superior sulcus deformity is shown in anophthalmic patient; (B) Deformity is corrected after fixating the graft to the periosteum. Function of the levator muscle is not impaired by weight of the graft and mechanical ptosis did not occur (arrow)

Reference

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