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. 2001 Oct;85(10):1183–1187. doi: 10.1136/bjo.85.10.1183

Autogenous hard palate mucosa: the ideal lower eyelid spacer?

M Wearne 1, C Sandy 1, G Rose 1, J Pitts 1, J Collin 1
PMCID: PMC1723739  PMID: 11567962

Abstract

BACKGROUND/AIMS—Raising a displaced lower eyelid frequently involves recession of the lower eyelid retractors with interposition of a "spacer," and several materials for this purpose have been described. This study reviewed the results of autogenous palatal mucosa in the treatment of lower eyelid displacement, including assessment of any donor site morbidity.
METHODS—A retrospective case note review of consecutive patients treated at Moorfields Eye Hospital between 1993 and 1998. All patients underwent insertion of hard palate mucosa between the inferior border of the tarsus and the recessed conjunctiva and lower eyelid retractors. Parameters studied included the underlying diagnosis, measurements of lower lid displacement or retraction, related previous surgery, the experience of the operating surgeon, intraoperative and postoperative complications, surgical outcome, and length of follow up. The main outcome measure was the position of the lower eyelid relative to the globe in primary position of gaze.
RESULTS—102 lower eyelids of 68 patients were included and a satisfactory lid position was achieved in 87/102 (85%), with inadequate lengthening or significant recurrence of displacement occurring in 15 cases. Donor site haemorrhage requiring treatment in the early postoperative period occurred in seven patients (10%).
CONCLUSION—Autogenous hard palate mucosa is an effective eyelid spacer and provides good long term support for the lower eyelid. Donor site complications are the main disadvantage, but may be minimised by attention to meticulous surgical technique and appropriate postoperative management.



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Figure 1  .

Figure 1  

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The thickness of palatal mucosa is greater with distance from the gingival margin, making the area "B" preferable to area "A" for harvesting mucosa. The mucosa is thinnest in area "C."

Figure 2  .

Figure 2  

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Osteology of the hard palate: "A" maxillary palatine processes; "B" horizontal processes of the palatine bones; "IF" incisive foramen; "GPF" greater palatine foramen.

Figure 3  .

Figure 3  

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Hard palate mucosa being harvested, using a disposable angled keratome.

Figure 4  .

Figure 4  

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Oro-nasal fistula at hard palate mucosa donor site.

Figure 5  .

Figure 5  

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Advancing epithelial edge (arrows) at mucosal donor site a week after surgery.

Figure 6  .

Figure 6  

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Thickening of the lower eyelid (A; black arrows) due to palatal buckling as a result of fibrosis alongside the graft (B; white arrow). Viewed from above at surgery.    

Figure 7  .

Figure 7  

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Patient referred with bilateral extrusion of polyester mesh (A), which had been used as a lower lid "spacer" (B).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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