Periosteal strip to increase the width of the palpebral fissure
Richard C. Allen, MD, PhD, FACS
Additional Notes: 02:36
This is Richard Allen at the University of the Iowa. This video demonstrates the use of a periosteal strip in order to lengthen the horizontal palpebral fissure width in a patient with blepharochalasis. Wescott scissors are used to perform a lateral canthotomy. The lateral orbital rim is identified and the orbicularis muscle is dissected from the underlying periosteum with a Freer periosteal elevator. A 15 blade is then used to make an incision through the periosteum of the lateral orbital rim externally. The Freer periosteal elevator is then used to elevate the periosteal strip from the underlying bone. It is important to not cut through the periosteal strip at this point. Dissection should be gentle and careful. Attention is then directed to the lower eyelid where dissection is carried out between the anterior and posterior lamella. A lateral tarsal strip is developed by making an incision inferior to the inferior border the tarsus. The mucocutaneous junction of the lateral tarsal strip is excised. The lateral tarsal strip is in placed into position with the periosteal strip. A 5–0 Vicryl suture is used to engage the periosteal strip. This is on a taper needle. The needle is placed in a mattress fashion so that the periosteal strip lies on top of the lateral lower eyelid. Tightening the suture puts the lower lid into position. The suture is then tied. The anterior lamella is then associated with the periosteal strip. This is sutured into position with interrupted 7-0 Vicryl sutures. This will associate the anterior lamella with the newly made posterior lamella of the periosteal strip. The lateral canthotomy incision is then closed with interrupted 7–0 Vicryl sutures. The eyelids appear to be in good position. The patient will follow-up in approximately 1 week for reevaluation.
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January 9, 2017