1991;24(5 Pt 1):715–9. We tightened the tarsus with a pentagonal wedge resection during the SMKS procedure; thus, the horizontal width of the chondromucosal graft was 5 mm shorter than the actual defect . Further tightening might be needed until the problem is adequately corrected. Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Practice Forms Library - Job Descriptions, MIPS Solo and Small Practice Survival Guide, 2020 MIPS Payments: Understanding Remittance Advice Codes, Final Checklist for EHR/Non-EHR 2019 MIPS Reporting, Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Global Programs and Resources for National Societies, Oculofacial Plastic Surgery Education Center, Patient management: treatment and follow-up, Preventing and managing treatment complications, International Society of Refractive Surgery. Two weeks after surgery, his right eye was comparable to left eye, with neither lagophthalmus nor trichiasis with marked improvement in cosmetic appearance. In image II. The tissue is then excised with the Westcott scissors. An upper eyelid injury can cause various symptoms associated with eyeball trauma, not just scar formation or eyelid deformity. At the end of the day, if a patient has skin cancer they owe it to themselves to have it evaluated by a board-certified dermatologist before deciding on any type of treatment. 2–3-mm incisions perpendicular to the lateral canthal angle and curvilinear lid crease incision. If concurrent upper-lid blepharoplasty will be performed, construct the apex of the pentagonal wedge to assimilate to the blepharoplasty incision. The pentagonal wedge resection specimen microscopically showed stratified squamous epithelium exhibiting orthokeratosis, parakeratosis, acanthosis, and irregular hyperplasia of the rete pegs. No preoperative medical evaluation is required. Author information: (1)Gavin Herbert Eye Institute, University of California, Irvine, Irvine. The presence of eyelid laxity should be assessed and documented, this would determine whether eyelid tightening procedures are needed. The sleep pattern is almost always responsible, except for rare cases with excessive lid rubbing. The total cost to the patient’s insurance was $1,340. Am J Ophthalmol 1981; 92:568. Br J Ophthalmol 2013; 97:1387. Corneal erosion can result from chronic mechanical abrasion and can lead to scarring. Small eyelid tumors (wedge resection) Full-thickness wedge resection is used to remove small eyelid tumors (Figure 7) or (as previously discussed) to shorten the eyelids from their lateral end when ectropion is due to euryblepharon. (4) When lid resection is performed, a pentagonal excision rather than a "V" or wedge resection should be used to minimize tension on the margin when closed. Lazy pentagonal wedge resection of eyelid margin lesions. 12 This was a prospective study in which horizontal surgical tightening alone by standard full-thickness pentagonal wedge resection was performed in 24 eyelids of 18 patients with a clinical diagnosis of floppy eyelid syndrome of the upper eyelid. C. coderguy1939 Guest. The edges of the defect are freshened and squared off with a 15 blade. Pentagonal wedge resection of upper eyelid Mark medially on lid margin to lid crease about 5 mm lateral to punctum and about 10 mm lateral the initial site depending on laxity. A full thickness pentagonal wedge resection is usually described.1 We perform a shortening in a semilunar form instead of a pentagonal form as usually described in other reports.1 A semilunar resection was easier and more cosmetic when joining the two ends (figure 6). DeBellis M et al. The nodule was … If reconstruction of the eyelid margin is to be carried out using a simple two-layer closure or a semicircular flap, a wedge or pentagonal resection of the mass should be performed. The orbicularis oculis muscle, which forms much of the core of the eyelid, was then closed with the 6-0 gut sutures. The pentagonal wedge resection is an effective treatment method that produces immediate relief of symptoms. J Am Acad Dermatol. That’s nearly 4 to 6 times the price that it would cost to have the skin cancer removed at our office-based clinic. A separate disease pattern of obstructive sleep apnea in children is associated with tonsil hypertrophy or craniofacial abnormalities. Are there frequent episodes of waking up during the night? Obesity contributes to airway obstruction and disrupted sleep. Metastatic basal cell carcinoma: report of twelve cases with a review of the literature. Metastatic basal cell carcinoma: report of twelve cases with a review of the literature. PMID: 29285530 [Indexed for MEDLINE] Publication Types: Video-Audio Media; MeSH terms. The conjunctiva (the most internal layer of the eyelid) and the orbital septum were repaired using 6-0 gut sutures with the tied knots facing outwards to … Sleep Breath 2012; 16:1033-40. Tear break-up time less than 10 seconds, indicating tear instability, Conjunctival papillary reaction from chronic irritation, Punctate fluorescein staining of superior cornea and conjunctiva. ... (typically via pentagonal wedge resection of the excess horizontal laxity). Difficulty achieving and maintaining a deep restorative phase of sleep leads to daytime somnolence and fatigue. When it’s all said and done, the same procedures at a hospital would cost from around $5,340 to $8,343. In lower lid wedge excision, palpebral conjunctival disruption is mostly away from the cornea, whereas upper lid wedge excision disrupts the palpebral conjunctiva in direct contact with the cornea. Severe upper lid laxity causes lash ptosis and loss of parallelism. The wedge can be located anywhere lateral to the limbus, and several techniques for this procedure have been described. The most vulnerable area of the lower lid is medial at the tear drainage system, whereas the vulnerable area of the upper lid is lateral where the lacrimal gland ductules emerge. Purpose: Pentagonal wedge resection is a technique used to address a wide variety of eyelid pathology. Culbertson WW, Ostler HB: The floppy eyelid syndrome. Eyelid surgery (lateral tarsal strip, pentagonal wedge resection) can help improve conjunctivitis like symptoms of discharge, irritation, and foreign body sensation. Blood thinners do not need to be stopped – their stoppage increases the risk of serious cardiac events like a heart attack or stroke. J Glaucoma 2014; 23:e81. Purpose: Pentagonal wedge resection is a technique used to address a wide variety of eyelid pathology. RESULTS Floppy eyelid syndrome as a subset of lax eyelid conditions: relationships and clinical relevance (an ASOPRS thesis). If IPL treatment sounds familiar, it might be because you’ve seen images that we’ve posted before to demonstrate how IPL reduced red and brown spots on our patient’s skin. The natural history is for the laxity to worsen and for the ocular surface irritation to persist and worsen. Wedge resection of eyelid margin in the treatment of abnormal eyelid margins. Methods This was a retrospective study reviewing the medical and surgical records of all patients undergoing entropion corrective surgery between May 2009 and May 2017. Saint Anthony, MN 55421. Pentagonal wedge resection (Figure 3) at the lateral third of the upper eyelid is a reasonable approach to tightening the upper lid. These images were taken from a patient who initially presented at Clarus Dermatology with a nonhealing sore near his eyelid. Garcia GA, Nguyen CV, Vo TA, et al. Ezra DG, Beaconsfield M, Collin R. Floppy eyelid syndrome: stretching the limits. 2603 39th Ave. NE, Suite D202 Basic eyelid biopsy (00:46) Biopsy of upper lid margin lesion (01:14) Full-thickness wedge biopsy (02:04) Posterior wedge resection (02:11) Excision of upper and lower xanthelasma #1 (02:37) Excision of upper and lower xanthelasma #2 (02:33) Excision of sub-brow lesion (01:59) Examination Videos Basic exam. In one study, 23% of obstructive sleep apnea patients with FES had glaucoma, while only 5% with OSA alone had glaucoma (Muniesa, J Glaucoma 2014). Floppy eyelid syndrome can be associated with other conditions including keratoconus and obstructive sleep apnea. FES is on a spectrum of lax eyelid conditions that vary in symptoms and severity (Fowler, OPRS 2010). Ophthalmology 2006;113:1669. This usually involves primary excision with either frozen section control or Moh’s technique. Lo JS, Snow SN, Reizner GT, et al. Operation was a wedge resection excisional biopsy of supicous lesion. FES was first described in 1981 by Culbertson and Ostler (AJO 1981; 92:568). The "dog ear" created by a large wedge excision in the lower lid will extend below the lid margin and can be blended into the skin tension lines, whereas the same excision in the upper lid creates a vertically oriented scar that runs perpendicular to and in the direction of the lid crease (. Thread starter codedog; Start date Aug 19, 2009; C. codedog True Blue. Histopathologic studies demonstrate decreased tarsal elastin and the tarsus becomes rubbery and lax (Ezra, Surv Ophthalmol 2010; 55:35). The rubbery eyelid is difficult to suture with perfect tissue apposition. An incision was made down partially through the tarsus. A full-thickness pentagonal wedge resection was performed in the upper eyelid at 5–7 mm of the external cantus. A lateral pentagonal upper eyelid resection was performed in the left eye, and eyelid tissue from the patient was examined using light microscopy and immunohistochemistry that revealed chronic conjunctival inflammation and papillary conjunctivitis. Lateral tarsal strip repair of the upper lid can be performed, but care must be taken to … Patients with obstructive sleep apnea are at increased risk of systemic and pulmonary hypertension, congestive heart failure, and cardiac arrhythmias. Copyright © Clarus Dermatology. Ropy, mucoid discharge that is usually worse in the morning. Messages 643 Best … Pihlblad MS, Schaefer DP: Eyelid laxity, obesity and obstructive sleep apnea in keratoconus. This rubbing can lead to excessive tearing, crusting of the eyelid, mucous discharge and irritation of the eye. The length of eyelid margin that is removed should be slightly shorter than the amount of correction needed because fibrosis and wound contraction provide an additional 0.5 to 1.0 mm of correction (see section on wedge and pentagonal resection below). Eye rubbing postoperatively and continued sleep disturbance can lead to disruption of the surgical wound and continued ocular irritation. In a prospective examination of 127 patients with OSA, 25% had FES, the association increasing with increased severity of OSA (Chambe, J Sleep Res 2012). Ezra DG, Beaconsfield M, Sira M, et al. When botulinum toxin failed to produce adequate functional improvements, the patient received bilateral upper eyelid blepharoplasty, pentagonal wedge resection for floppy eyelids, and limited myectomy of both upper lids. Eyelid biopsy. This uncertainty is the weak point of this procedure, and excess vertical resection of the lower eyelid may induce ectropion. Lazy pentagonal wedge resection of eyelid margin lesions. Posterior wedge resection #2 (03:01) Repair lower lid defect with cantholysis (02:28) Tenzel flap (03:35) Repair of 40% full-thickness defect of the lower eyelid (02:35) Repair of 50% of the lower eyelid (02:31) Repair of 50% central full-thickness lower eyelid defect (06:54) Repair of 50% lower eyelid defect with a periostal strip (05:37) The amount of eyelid resected was determined by the surgeon during the procedure by superposition of the surgical flaps. Lazy Pentagonal Wedge Resection of Eyelid Margin Lesions. ... For small tumors a wedge resection or pentagonal excision is done. Muniesa M, Sanchez-de-la-Torre M, Huerva V, Lumbierres M, Barbe F: Floppy eyelid syndrome as an indicator of the presence of glaucoma in patients with obstructive sleep apnea. Once done, board-certified dermatologist Dr. Shah looked at the microscopic slides of the skin and determined that more tissue needed to be taken during the second stage to clear the tumor. 2020 Feb;21(1):49-52. doi: … Small tumors are usually removed by pentagonal wedge resection. The wedge excision can be performed in the medial third of the lid. Ocular lubrication at night can protect the eye from exposure. Aug 19, 2009 #1 Patient had a confirmed basal cell carcinoma of left lower eyelid. Results: Postoperative improvements in cellular mor- phology and goblet cell count were found in 20 of 22 eyelids (91%) and this led to a decrease of least one grade in Nelson’s classification. Acta Ophthalmol. The patient previously had a Mohs excision of a basal cell carcinoma. The procedure consists of horizontal shortening of the lower lid by a pentagonal wedge resection combined with an infratarsal eyelid suture technique. Atrophic, soft, and rubbery tarsal plate that can be folded on itself. The diagnosis is established on clinical grounds. The Mohs surgery and closure of the defect are basically painless after local anesthesia. [13] Conservative Therapy. Remember to use a pentagonal wedge excision in the upper lid when removing a large lesion; other wedge excisions can cause lid … This procedure frequently results in excess skin at the apex of the wound, commonly known as a "dog ear." Many have a chief complaint of ptosis and some are specifically aware of lash ptosis, a sign of severe lid laxity — "I'm looking through my eyelashes.". É grátis para … Muniesa MJ, Huerva V, Sánchez-de-la-Torre M, et al: The relationship between floppy eyelid syndrome and obstructive sleep apnea. A proper pre-operative assessment and surgical planning takes one already half way through the surgery. In obstructive sleep apnea, the pharynx easily collapses during inspiration, resulting in loud snoring and eventual apnea, causing the patient to awaken. This procedure frequently results in excess skin at the apex of the wound, commonly known as a "dog ear." Slightly more prevalent in men than women, Most commonly diagnosed in middle-aged patients (35–55 years). Floppy eyelid syndrome can be associated with other conditions including keratoconus and obstructive sleep apnea. To describe the effectiveness of combined pentagonal resection and inferior retractor plication (PR + IRP) based on the Hill’s procedure for the treatment of primary involutional lower eyelid entropion in the Chinese population. 1995 Nov;113(11):1458-9. The associations of floppy eyelid syndrome: a case control study. Influence of weight and sleep apnea status on immunological and structural features of the uvula. Am J Respir Crit Care Med 2004;170:1114-9. Paradoxically, horizontal tightening of the upper eyelid can result in elevation of the lid margin, typically 1.5–3.5 mm (Figure 4) (Mills, Ophthalmology 2007). A temporally placed back-tapered wedge resection and advancement flap can be performed to create a wound that is more nearly parallel to the eyelid crease, potentially camouflaging it (Perlman, OPRS 2002). JAMA Facial Plast Surg. The eyelids play an important role in protecting the globe. Hypertension and congestive heart failure are frequently sequelae of chronic obstructive sleep apnea. For medial punc-tal eversion a medial spindle resection from the posterior lamella works well. 2018;20:251–2. Wedge resection. Ophthalmology 2010;117:831. We … Find the best information and most relevant links on all topics related toThis domain may be for sale! Fowler AM, Dutton JJ. and IV. If the eyelid resection is wedge shaped, the repair or approximation of the lid results in a notch or valley of the eyelid margin at the incision site. Most classic descriptions of eyelid resection involve the 'V" or wedge excision. Medium-sized tumors often require reconstruction with transpositional flaps (Tenzel, Mustarde, Glabellar). Pentagonal wedge resection to release a retracted structure, fat redistribution to prevent readhesion, and full-thickness skin grafting for enough amount of skin to regain upper eyelid function is useful for scar release and lagophthalmos following crushing injuries of the upper eyelid. Mehta VJ, Ling J, Sobel RK. Author information: (1)Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, College of Medicine, USA. In my experience, simply shaving lesions like this off flush with the eyelid margin results in recurrence weeks to months after removal. This video demonstrates a lower lid wedge resection with repair of the lower lid. (above) the carcinoma has been cleared and what you see is the post-clearance defect – the tumor after all of the skin cancer was removed. They form a barrier for the eyes against trauma, excessive light, and help in maintaining the tear-corneal film and also aid in pumping the tears toward the nasolacrimal duct system. Then, we made subciliary incisions beyond the lateral canthus, and the flap was elevated along with the orbicularis septum under the orbicularis oculi muscle. resection at the junction of the central and lateral thirds of the lid is preferred. There is an association with keratoconus (Ezra, Ophthalmology 2010), which might be from chronic eye rubbing as well as obesity and lid laxity (Pihlblad, Cornea 2013). In our case, no recurrence was … • Surgery involving full-thickness pentagonal resection or anterior lamellar rotation excision may be performed for segmental trichiasis resistant to other methods of treatment. Eyelids can be taped and eye shield can be worn while asleep. Pentagonal wedge resection shortens the lid in the horizontal plane. Conjunctival scrapings reveal predominance of polymorphonuclear leukocytes with variable amounts of eosinophils and lymphocytes. In another screening study of 44 patients with obstructive sleep apnea, only one patient had floppy eyelid (Karger, Ophthalmology 2006). The specimen of eyelid tissue obtained was analysed by a pathologist. Pentagonal wedge resection (Figure 3) at the lateral third of the upper eyelid is a reasonable approach to tightening the upper lid. The eye and sleep apnea. If... Rejuvapen is a microneedling treatment that we use at Clarus Dermatology for a variety of skin care issues - including ones related to sun damage and melasma (a common skin... Clarus Dermatology Physicians and Physician Assistants, Using IPL+RF to Significantly Reduce the Appearance of Dilated Blood Vessels and Reds on the Skin, Using Intense Pulsed Light (IPL) Treatment to Reduce Redness on the Skin, How Rejuvapen Can Help Skin Care Issues Related to Sun Damage. General: The goal should be total removal of the cancer. Lo JS, Snow SN, Reizner GT, et al. Busque trabalhos relacionados com Pentagonal wedge resection eyelid cpt code ou contrate no maior mercado de freelancers do mundo com mais de 19 de trabalhos. Putterman AM(1). While you are correct, pentagonal wedge sounds scary, be reassured that in most cases the shape of the eye does not change drastically. Full-thickness pentagonal wedge resection and repair is a mainstay in the treatment of eyelid neoplasms, trichiasis, and other eyelid pathologic abnormalities.1-3 Traditionally, when performed on the lower eyelid, incisions are made in a symmetric pentagon surrounding the lesion. We at Clarus Dermatology believe that using local anesthesia is safer than general anesthesia. Series F et al. Website by Minnesota Design Studio. Arch Ophthalmol. No data is available regarding prevalence of FES or histopathologic evidence of tarsal abnormalities in these children. combined pentagonal resection and inferior retractor plica-tion (PR+IRP) for primary treatment of involutional en-tropion with lower eyelid laxity in our Chinese population. Eyelid height or contour might be unacceptable and require revision. Garcia GA, Nguyen CV, Vo TA, et al. In terms of cost, the patient and their health insurance saved a tremendous amount of money by having the procedures done at Clarus Dermatology, an independent clinic. In the case of FES, nocturnal eye shields can be considered. Purpose: Pentagonal wedge resection is a technique used to address a wide variety of eyelid pathology. Screening for obstructive sleep apnea among floppy eyelid patients is also recommended by some, and the yield is potentially higher (85% in the BJO study above). Once the mechanical laxity has been adequately corrected, the inflammation should improve. In this report, we describe a case of lagophthalmos observed after wou … Early Cicatricial Lagophthalmos Release With Pentagonal Wedge Resection of the Scar, Fat Redistribution, and Full-Thickness Skin Grafting Arch Craniofac Surg. Complications from the disease occur mostly at the corneal surface. Not sure about this code-that is, any ideas ? Coexisting elastin changes in the uvula have been noted (Series, Am J Respir Crit Care Med 2004), pointing to a possible systemic fibroblastic anomaly. Daytime somnolence and morning headaches suggest obstructive sleep apnea. Upper eyelid defects involving one third or less of the horizontal length of the upper eyelid usually can be repaired by direct closure. Patients most commonly complain about conjunctival injection and foreign body sensation. While addressing the eyelid, metabolic problems should be addressed. Progressive stretching leads to upper eyelid eversion at night and mechanical irritation of exposed conjunctiva especially during sleep, causing chronic papillary conjunctivitis. Chambe J, Laib S, Hubbard J, et al: Floppy eyelid syndrome is associated with obstructive sleep apnea: a prospective study on 127 patients. When you have skin cancer in a high-risk area like the eyelid, the optimal treatment for the patient is Mohs surgery. The sleep pattern is associated with obstructive sleep apnea. Dr. Craig Roelke, a partner at the clinic, obtained a biopsy and interpreted the sore as basal cell carcinoma – a common, slow-growing skin cancer. Cornea 2013; 32:1232. Full-thickness pentagonal wedge resection and repair is a mainstay in the treatment of eyelid neoplasms, trichiasis, and other eyelid pathologic abnormalities.1-3 Traditionally, when performed on the lower eyelid, incisions are made in a symmetric pentagon surrounding the lesion. • A simple surgical procedure in which the anterior lamella is removed, and the eyelid is allowed to heal by spontaneous granulation, has been described for severe trichiasis. Discontinuing PGA analog use can be considered. The area of the defect was closed with a method similar to what is called a pentagonal wedge resection of the eyelid. Screening for floppy eyelid among sleep apnea patients is recommended by some, but the yield is not high (McNab, Sleep Med Rev 2007). Raising the upper lid accentuates lid margin irregularities and notching after wedge excision on the upper lid. Board-certified dermatologist Dr. Neil Shah successfully performed the surgery at the clinic and only local anesthesia was needed for the procedure. Horizontally tightening the lower lid does not significantly change its position because it is a straight line, whereas horizontally tightening the upper lid can induce a ptosis because it is an arc. The tarsus, a firm band of tissue running across the eyelid, was then approximated using 5-0 Vicryl sutures. The fee to walk in the door is usually around $2,000 – $5,000 alone, with another $2,000 for general anesthesia. Methods This was a retrospective study reviewing the medical and surgical records of all patients undergoing entropion corrective surgery between May 2009 and May 2017. The two incision sites should ideally be adequately separated, for example, by performing a wedge excision in the upper lid and lateral tarsal strip procedure in the lower lid. Immunohistochemical and histomorphometric study of human uvula innervation: a comparative analysis of non-snorers versus apneic snorers. Cautery was then used to provide hemostasis. When it comes to the treatments that we perform at Clarus Dermatology, IPL (Intense Pulsed Light) consistently delivers results for our patients. Eyelid surgery (lateral tarsal strip, pentagonal wedge resection) can help improve conjunctivitis like symptoms of discharge, irritation, and foreign body sensation. Incision through the eyelid should be perpendicular to the lid margin. The conjunctiva (the most internal layer of the eyelid) and the orbital septum were repaired using 6-0 gut sutures with the tied knots facing outwards to avoid scratching the cornea. Ophthal Plast Reconstr Surg 2002; 18:370. Sleep apnea can be treated with positive pressure ventilation. This is a retrospective review of 52 eyelids of 46 patients who underwent PR + IRP for treatment of involutional entropion between May 2009 and May 2017. Reduced innervation of pharyngeal musculature has been reported in obstructive sleep apnea (De Bellis, Sleep Breath 2012) but not in the eyelid. Lash ptosis can persist despite adequate lid tightening. Wedge and Pentagonal Resection. 75 B. There might be visual complaints related to keratopathy. Garcia GA(1), Nguyen CV(1), Vo TA(1), Yonkers MA(1), Minckler DS(1), Tao JP(1). Procedure performed: wedge resection of lower eyelid Procedure: ... after anesthesia ... a pickups was used to elevate the lesion, and a wedge resection was performed utilizing Westcott scissors. Lid tightening procedures including lateral tarsal strip (LTS) surgery [5, 9, 10] and wedge resection have been well documented to be effective in the treatment of involutional entropion. Defects greater than 50% may require a semicircular or pedicle-based flap ( Chapter 38 , Chapter 39 , Chapter 40 , … The epidermis (the outer skin surface) was closed with 6-0 gut sutures using a method that pins down the sutures near the eyelid margin, to aim them towards the feet, so that they don’t flip upwards and irritate the eye. J Sleep Res 2012; 21:308. Pentagonal excision of posterior lamella. The wedge can be located anywhere lateral to the limbus, and several techniques for this procedure have been described. Can be confused with involutional changes if upper lid laxity is not recognized. Ectropion is the medical term used to represent sagging and outward turning of the lower eyelid and eyelashes. Full-thickness pentagonal wedge resection and repair is a mainstay in the treatment of eyelid neoplasms, trichiasis, and other eyelid pathologic abnormalities.1-3 Traditionally, when performed on the lower eyelid, incisions are made in a symmetric pentagon surrounding the lesion. 1. The basal cell carcinoma tumor required two stages to completely clear. The upper eyelid reconstruction was performed by doing transverse skin resection of the upper eyelid and lateral canthal attachment of both upper and lower tarsal plates to the periosteum. A full-thickness pentagonal wedge resection was performed in the upper eyelid. There is frequently lower eyelid horizontal laxity as well. This doesn’t even include the costs for surgical procedures (the removal, pathology, and reconstruction that was detailed above), which would be similar to the $1,340 that our clinic billed. A full thickness pentagonal wedge resection is usually described.1 We perform a shortening in a semilunar form instead of a pentagonal form as usually described in other reports.1 A semilunar resection was easier and more cosmetic when joining the two ends (figure 6). Perlman LM, Sires BS: Floppy eyelid syndrome: A modified surgical technique. Medium-sized tumors often require reconstruction with transpositional flaps (Tenzel, Mustarde, Glabellar). McNab AA. Author information: (1)Gavin Herbert Eye Institute, University of California, Irvine, Irvine. 2016 68 May;94(3):257-60. Accurate closure of the margin with the figure-8 suture is of utmost importance to prevent postoperative corneal irritation … Choosing an independent clinic like Clarus Dermatology will provide patients with a high-quality, safe outcome at a lower cost than hospital-based or large health system alternatives. Always avoid the medial canthal area and nasolacrimal apparatus. The area of the defect was closed with a method similar to what is called a pentagonal wedge resection of the eyelid. Defects greater than 50% may require a semicircular or pedicle-based flap ( Chapter 38 , Chapter 39 , Chapter 40 , … The details of how to perform a wedge resection can be found in the “Surgical Techniques” notes as well as in texts. This usually involves primary excision with either frozen section control or the Moh’s technique. Each resection was performed at the junction between the lateral one third and medial two thirds of the eyelid using a standard full-thickness pentagonal wedge excision, adjusting the amount of resection during surgery to the amount of laxity present. The lower lid is static, whereas the upper lid is dynamic. She agreed instead to a pentagonal wedge resection and ectropion repair for the lax eyelid, and external levator repair for ptosis. There are signs of chronic irritation and inflammation at multiple locations on and around the eye. The lower lid tarsus has a constant height of 4 mm across the horizontal span, whereas the upper lid tarsus has a variable height of 3–10 mm. The margin of the eyelid and the eyelashes evert (turn out) . Lateral tarsal strip repair of the upper lid can be performed, but care must be taken to avoid trauma to lacrimal gland ductules. So we need to know: - If the defect is full-thickness with eyelid margin involving or just anterior lamellar defect ; Size of defect - amount of … Early cicatricial lagophthalmos release with pentagonal wedge resection of the scar, fat redistribution, and full-thickness skin grafting February 2020 Archives of Craniofacial Surgery 21(1):49-52