Periosteal strip for lateral canthal disinsertion in patient with blepharochalasis
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 03:32
This is Richard Allen at University of Iowa. This video demonstrates a patient with blepharochalasis. The patient has had a history of recurrent eyelid swelling which has resulted in horizontal phimosis of the eyelids. A periosteal strip will be performed in order to widen the palpebral fissure. A lateral canthotomy has been performed. The lateral orbital rim is identified, and the orbicularis muscle is dissected from the periosteum of the lateral orbital rim. A 15 blade is then used to make an incision along the periosteum of the lateral orbital rim in order to develop a periosteal strip. This is then raised with a Freer periosteal elevator. The goal here will be to obtain a periosteal strip which can be reflected medially and engage the tarsus of the lower eyelid. Dissection is then carried out between the anterior and posterior lamella along the lateral portion of the lower eyelid. A 5–0 Vicryl suture is then used to engage the periosteal strip. This then engages the lateral tarsus of the lower lid. This is going to be placed in a horizontal mattress fashion so that the periosteal strip lays on top of the tarsus. This will essentially lengthen the posterior lamella of the lower lid. The suture is left untied. The upper eyelid is then engaged with the 5–0 Vicryl suture which also engages the periosteal strip in order to give lateral stabilization of the upper eyelid. The suture of the periosteal strip is then tied. This results in widening of the palpebral fissure as compared to the contralateral side. The anterior lamella is then sutured laterally to the periosteal strip with 7-0 Vicryl suture. The lateral canthotomy incision is then closed with interrupted 7–0 Vicryl sutures. Inspection of the eyelids show that they are in good position and in good tension. The lateral canthus appears to be well positioned. Erythromycin ophthalmic ointment will be placed over the incisions 3 times a day and the patient will return in approximately 1 week for re-evaluation.
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