DOI QR코드

DOI QR Code

Use of Triamcinolone Acetonide to Treat Lower Eyelid Malposition after the Subciliary Approach

  • Park, Hyun June (Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine) ;
  • Son, Kyung Min (Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine) ;
  • Choi, Woo Young (Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine) ;
  • Cheon, Ji Seon (Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine) ;
  • Yang, Jeong Yeol (Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine)
  • Received : 2015.10.08
  • Accepted : 2015.12.17
  • Published : 2016.06.20

Abstract

Background: The subciliary approach is commonly used for reconstruction of orbital wall or zygomaticomaxillary fractures. However, this approach is associated with postoperative complications, especially lower eyelid malposition. We report the experience of managing postoperative lower eyelid malposition with triamcinolone acetonide. Methods: A retrospective review was performed for all traumatic facial fractures requiring surgery via the subciliary approach at Chosun University Hospital in 2014. For each patient meeting inclusion criteria, the medical chart was reviewed for demographic information and postoperative course, including the presence of postoperative eyelid malposition or scleral show. Results: The review identified 189 cases in which the subciliary approach was used, and postoperative lower eyelid malposition was found in 7 cases (3.7%). For these 7 patients, the mean therapeutic period (interval to correction of the malposition) was 10.5 weeks (range, 8 to 14 weeks). On average, patients received 3 injections of triamcinolone. In all cases, degrees of the malposition were improved, and none of the patients required an operative intervention to correct the malposition. Conclusion: Triamcinolone injection is an appropriate treatment modality for lower eyelid malposition after subciliary approach. Treatment duration is relatively short, requiring fewer than 4 outpatient clinic visits, with relatively earlier recovery compared to conservative "wait-and-see" management.

Keywords

References

  1. Converse J. Two plastic operations for repair of orbit following severe trauma and extensive comminuted fracture. Arch Ophthalmol 1944;31:323-5. https://doi.org/10.1001/archopht.1944.00890040061010
  2. Rohrich RJ, Janis JE, Adams WP Jr. Subciliary versus subtarsal approaches to orbitozygomatic fractures. Plast Reconstr Surg 2003;111:1708-14. https://doi.org/10.1097/01.PRS.0000054209.18400.4E
  3. Yun CS, Kim JH, Yang HJ. The usability of infraorbital approach on the patients with orbito-zygomatic fracture. J Korean Cleft Palate-Craniofac Assoc 2009;10:19-22.
  4. Bahr W, Bagambisa FB, Schlegel G, Schilli W. Comparison of transcutaneous incisions used for exposure of the infraorbital rim and orbital floor: a retrospective study. Plast Reconstr Surg 1992;90:585-91. https://doi.org/10.1097/00006534-199210000-00006
  5. Appling WD, Patrinely JR, Salzer TA. Transconjunctival approach vs subciliary skin-muscle flap approach for orbital fracture repair. Arch Otolaryngol Head Neck Surg 1993;119:1000-7. https://doi.org/10.1001/archotol.1993.01880210090012
  6. Ridgway EB, Chen C, Colakoglu S, Gautam S, Lee BT. The incidence of lower eyelid malposition aer facial fracture repair: a retrospective study and meta-analysis comparing subtarsal, subciliary, and transconjunctival incisions. Plast Reconstr Surg 2009;124:1578-86. https://doi.org/10.1097/PRS.0b013e3181babb3d
  7. Salgarelli AC, Bellini P, Multinu A, Landini B, Consolo U. Tarsal strip technique for correction of malposition of the lower eyelid aer treatment of orbital trauma. Br J Oral Maxillofac Surg 2009;47:298-301. https://doi.org/10.1016/j.bjoms.2009.01.019
  8. Patipa M. The evaluation and management of lower eyelid retraction following cosmetic surgery. Plast Reconstr Surg 2000;106:438-53. https://doi.org/10.1097/00006534-200008000-00033
  9. Goldberg RA, Lee S, Jayasundera T, Tsirbas A, Douglas RS, McCann JD. Treatment of lower eyelid retraction by expansion of the lower eyelid with hyaluronic Acid gel. Ophthal Plast Reconstr Surg 2007;23:343-8. https://doi.org/10.1097/IOP.0b013e318137aa41
  10. Holtmann B, Wray RC, Little AG. A randomized comparison of four incisions for orbital fractures. Plast Reconstr Surg 1981;67:731-7. https://doi.org/10.1097/00006534-198106000-00003
  11. Khan MA, Bashir MM, Khan FA. Intralesional triamcinolone alone and in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. J Pak Med Assoc 2014;64:1003-7.
  12. Kelly AP. Medical and surgical therapies for keloids. Dermatol Ther 2004;17:212-8. https://doi.org/10.1111/j.1396-0296.2004.04022.x
  13. Burm JS, Kim BY, Kim YW. Prevention of lower eyelid complications caused by a subciliary approach: temporary lower eyelid suspension. J Korean Soc Plast Reconstr Surg 2006;33:465-8.