The Cosmetic Effects of Full Thickness Eyelid Resection and Direct Closure for Eyelid Malignant Tumors

Dong Eun Lee; Seung Hwan Jo; Dong Sik Ham; Jung Jae Lee; Jae Wook Yang

doi:10.3341/jkos.2018.59.2.110

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Lee, Jo, Ham, Lee, and Yang: The Cosmetic Effects of Full Thickness Eyelid Resection and Direct Closure for Eyelid Malignant Tumors

Original Article

J Korean Ophthalmol Soc 2018;59(2):110-116.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.2.110

The Cosmetic Effects of Full Thickness Eyelid Resection and Direct Closure for Eyelid Malignant Tumors

Dong Eun Lee, MD^1,², Seung Hwan Jo, MD^1,², Dong Sik Ham, MD³, Jung Jae Lee, MD⁴, Jae Wook Yang, MD, PhD^1,^2,

¹Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

²T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

³Department of Ophthalmology, Dong-Eui Medical Center, Busan, Korea

⁴Ulsan Shinsaegae Eye Clinic, Ulsan, Korea

Address reprint requests to Jae Wook Yang, MD, PhD Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: 82-51-890-6356, Fax: 82-51-890-6329 E-mail: oculoplasty@gmail.com

Received 19 October 2017 Revised 10 November 2017 Accepted 20 January 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the degree of eyelid deformation and satisfaction after direct closure in patients with 40–70% eyelid defects after resection of an eyelid malignant tumor.

Methods

We retrospectively reviewed the clinical records of patients diagnosed with eyelid malignant tumors between January 2009 and June 2016, who were treated with resection of 40–70% of the eyelid, followed by reconstructed direct closure only or by direct closure with lateral canthotomy and cantholysis. Age, sex, diagnosis, tumor location, satisfaction, and complications were analyzed, and the ratio of horizontal width ratio and vertical height ratio were compared before and after surgery.

Results

The results of satisfaction were: 12 patients (60%), very good; five patients (25%), good; and three patients (15%), fair. The average preoperative horizontal width ratio and vertical height ratio were 1.03 ± 0.01 and 1.08 ± 0.30, respectively. The average postoperative horizontal width ratio and vertical height ratio were 1.04 ± 0.08 and 1.01 ± 0.17, respectively There was no significant difference in horizontal width ratio or vertical height ratio before and after surgery (p = 0.314 and p = 0.087, respectively).

Conclusions

Eyelid reconstruction with a direct closure can be performed without a flap or graft for 40–70% of eyelid defects when resecting the eyelid of a malignant eyelid tumor.

Keywords: Direct closure, Eyelid reconstruction, Malignant eyelid tumor

References

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Figure 1.

An example of photograph. It shows how to measure vertical height ratio and horizontal width ratio in pre-operative photograph. The pre-operative horizontal width ratio of eyelid is obtained by dividing the horizontal width of eyelid in the contralateral (b) from the horizontal width of eyelid in the lesion (a). Pre-operative vertical height ratio of eyelid is obtained by dividing the vertical height of eyelid in the contralateral (d) from the vertical height of eyelid in the lesion (c). Pre-HR = pre-operative horizontal width ratio of eyelid; Pre-VR = pre-operative vertical height ratio of eyelid.

Figure 2.

Statistical results box plots. It shows the distribution of horizontal ratio and vertical ratio of eyelid (y-axis) in preoperative and postoperative photographs (x-axis). The box plots show the median, interquartile range, 95% percentile, outliers, and extreme values. Pre op = in preoperative photographs; Post op = in postoperative photographs.

Figure 3.

Patient's photographs included in the series. (A) The preoperative left lower lid squamous cell carcinoma, which measured 0.333 in its horizontal width ratio of eyelid mass. (B) The 3 month postoperative result after about 45% horizontal lid resection and direct closure. (C) Photograph also taken at 3 months and it allows a comparison with the normal unoperated right eye. (D) The pre-operative left lower lid sebaceous carcinoma, which measured 0.318 in its horizontal width ratio of eyelid mass. (E) The 3 month postoperative result after about 41% horizontal lid resection and direct closure. (F) Photograph also taken at 3 months and it allows a comparison with the normal unoperated right eye.

Table 1.

Raw data of patients

Patient	Sex	Age	Diagnosis	Lid	Satisfaction	Pre-HR	Pre-VR	Post-HR	Post-VR	M-HR	M-VR	Canthotomy or cantholysis	Complication 3 months
1	M	65	BCC	Lower	Very good	0.978	1.098	1.064	0.817	0.311	0.446	–	–
2	F	82	BCC	Lower	Good	0.962	1.136	0.974	0.929	0.320	0.440	–	–
3	M	65	BCC	Lower	Very good	0.971	1.167	0.947	1.071	0.488	0.371	–	–
4	F	78	BCC	Lower	Very good	0.976	0.857	0.972	0.826	0.346	0.417	Yes	–
5	F	89	BCC	Lower	Very good	1.000	1.143	1.042	1.091	0.325	0.375	–	–
6	F	68	BCC	Lower	Fair	1.125	1.286	1.024	1.167	0.399	0.337	–	–
7	F	78	BCC	Lower	Very good	1.268	1.000	1.025	1.000	0.454	0.352	–	–
8	F	78	SCC	Lower	Very good	0.933	0.966	1.130	1.040	0.333	0.233	–	–
9	F	87	Sebaceous carcinoma	Upper	Good	1.000	1.100	0.972	1.077	0.318	0.348	Yes	–
10	F	81	Merkel cell carcinoma	Upper	Very good	1.020	1.000	0.962	0.867	0.429	0.396	–	–
11	F	79	Sebaceous carcinoma	Lower	Good	0.988	0.909	1.154	0.900	0.315	0.305	Yes	–
12	F	74	SCC	Lower	Very good	0.929	1.000	1.200	1.133	0.308	0.478	Yes	–
13	F	63	Sebaceous carcinoma	Upper	Good	1.028	1.000	1.074	0.964	0.389	0.400	–	–
14	M	68	BCC	Lower	Very good	1.031	1.163	1.042	0.909	0.316	0.419	–	–
15	F	74	BCC	Upper	Very good	0.960	0.951	1.114	0.802	0.377	0.313	–	–
16	F	45	BCC	Lower	Fair	0.988	1.030	1.196	1.023	0.445	0.385	–	–
17	M	70	BCC	Upper	Very good	1.239	0.909	0.924	1.533	0.354	0.429	–	–
18	M	52	BCC	Lower	Good	0.957	0.962	0.972	0.846	0.378	0.200	–	–
19	M	43	BCC	Lower	Fair	1.000	1.118	1.029	1.065	0.414	0.311	–	–
20	M	65	BCC	Upper	Very good	0.966	0.857	1.044	1.095	0.429	0.267	–	–

Pre-HR = pre-operative horizontal width ratio of eyelid; Pre-VR = pre-operative vertical height ratio of eyelid; Post-HR = post-operative horizontal width ratio of eyelid; Post-VR = post-operative vertical height ratio of eyelid; M-HR = horizontal width ratio of eyelid mass; M-VR = vertical height ratio of eyelid mass; M = male; F = female; BCC = basal cell carcinoma; SCC = squamous cell carcinoma.

Table 2.

Comparison of eyelid deformations between pre and post operation

	Pre op	Post op	p-value^*
HR	1.03 ± 0.01	1.04 ± 0.08	0.314
VR	1.08 ± 0.30	1.01 ± 0.17	0.087

Values are presented as mean ± SD unless otherwise indicated. Pre op = pre-operative mean value; Post op = post-operative mean value; HR = horizontal width ratio (lesioned eyelid/normal eyelid); VR = vertical height ratio (lesioned eyelid/normal eyelid).

^* Mann-Whitney test.

Table 3.

Comparison of eyelid deformations between two age groups

	<60 (years)	≥60 (years)
AD-HR	0.084	0.108
AD-VR	0.088	0.133

AD-HR = mean absolute differences between pre and post operative horizontal width ratio of eyelid; AD-VR = mean absolute differences between pre and post operative vertical height ratio of eyelid.

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