Combined Chondromucosal Graft and Cervicofacial Flap

The authors of the following presentation have no financial disclosures. Good afternoon. My name is Emily Lee, and I'll be presenting the combined chondro mucosal graft and cervical facial flap. The kitchen sink treatment for severe recalcitrant lower eyelid retraction In severe cases of lower eyelid retraction, surgical techniques that address mild to moderate cases cannot stop the relentless cycle of recurrence. We propose that after throwing everything but the kitchen sink at intractable lower eyelid retraction, it's time to implement the kitchen sink approach in order to achieve durable symptom relief and anatomic success. The method consists of a nasal chondral mucosal graft to augment posterior la mellor height and the rotation of the cervical facial flap to fill in the anterior lamella. To help demonstrate our technique, we present three patients who had histories of five or more prior lower eyelid surgeries with recurrent retraction requiring the kitchen sink approach to provide ultimate repair. The first step of reconstruction consists of careful dissection to release scar tissue, lamellar dissection is carried down to the orbital rim. Next, a composite chondro mucosal graft is harvested from the nasal septum close to the floor of the nasal cavity. The graft is then secured to the inferior orbital rim, periosteum and superiorly to the inferior border of the native lid margin. If it's intact, then a cervical facial flap is elevated and rotated into place for anterior la mell reconstruction. The inferior extent of the flap depends on the patient's facial laxity. The dissection plane is in the subcutaneous fat, deep enough to preserve the subdermal vascular plexus. The flap is then secured to the lateral orbital rim. All patients had improved symptoms in Ferris Sclero S show and leg ophthalm. While traditional more conservative surgical approaches can adequately treat mild to moderate cases, we propose the combined chondro mucosal graft and cervical facial FLA reconstruction is the most powerful surgical solution to recalcitrant lower eyelid retraction. Thank you so much for your time and attention.