PMC5592914_01
An extensive left upper eyelid mass.. Notes: The elevated, firm, irregular multinodular mass involved left total upper eyelid, compromised the corneal surface integrity, and was associated with complete ptosis.
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External examination revealed mild telangiectasia on the left upper eyelid with a mass consisting of multiple, firm, thickened, irregular nodules (Figure 1).
Surgical technique for single-staged total upper eyelid reconstruction after sebaceous gland carcinoma excision.. Notes: The tumor was extensively removed by excision of the full-thickness eyelid with extension to inferior eyebrow, and medial and lateral canthi (A). A hard palate graft was secured to the remnants of the conjunctiva at the resection eyelid borders as posterior lamella. The isolated forehead galeal pericranial flap (B) was used as a tough supportive connective tissue (C, coronal or D, sagittal planes) to suture the remnant of the resected upper eyelid borders (E) and stump of the levator aponeurosis. Finally, a full-thickness skin graft overlying galeal pericranial flap was harvested to reconstruct the anterior lamella (F).
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Then under general anesthesia, we performed total removal of the tumor in the left upper lid including superior conjunctival fornix and nearly total removal of levator muscle resulting in the full-thickness eyelid defect measuring 4.5x1.5 cm, extending from the medial and lateral canthi to the inferior eyebrow (Figure 2A). Then we obtained the galeal pericranial flap measuring 4x4.5 cm by an incision along the frontal skin crease above the eyebrow through the skin, and subcutaneous tissues, dissection above the frontalis muscle, and vertical relaxing incisions medially and laterally (Figure 2B, illustrated as 2C [coronal plane] or 2D [sagittal plane]). The upper margin of the galeal pericranial flap was sutured with 6-0 Vicryl to the remnant of the resected medial and lateral left upper eyelid borders (Figure 2E). Finally, a full-thickness skin graft was harvested from the patient's inguinal area to cover the external surface of the galeal pericranial flap to reconstruct the anterior lamella (Figure 2F).
Surgical outcome.. Notes: Ocular symptoms completely resolved and the flaps and grafts were viable. Patient had acceptable eye lid closure (A) and 3-4 mm eyelid opening (B) after the surgery.
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Patient had acceptable eyelid closure (Figure 3A) and regained 3-4 mm eyelid opening (Figure 3B).