title: Modified auricular cartilage sling for paralytic ectropion.
abstract: OBJECTIVE
  To evaluate the outcomes of a modified auricular cartilage sling for paralytic ectropion.
  
  
  METHODS
  We treated 17 eyelids of 17 patients (average 67 years old) with an auricular cartilage sling between 2004 and 2012. All patients had paralytic ectropion with lower eyelid ptosis. Cartilage was harvested via an incision just inside the anterior rim of the helix. Skin incisions were made at the subciliary, medial and lateral canthal regions. The auricular cartilage graft was sutured to the medial canthal tendon medially, lateral orbital rim laterally, inferior tarsus superiorly, and lower eyelid retractors inferiorly. Average follow-up period was 40 months (range 16-60 months).
  
  
  RESULTS
  The median L-MRD (mm) was improved from 8.4 preoperatively (interquartile range 7.5-8.9) to 5.2 postoperatively (4.8-5.3). The median lagophthalmos (mm) was improved from 5.8 preoperatively (4.7-7.0) to 2.2 postoperatively (1.6-2.6). 16 patients had corneal exposure preoperatively and this resolved completely in 12 patients. All patients experienced good anatomical and functional results with relief of their preoperative pain/discomfort symptoms without complications. No patients required reoperation and none experienced infection, exposure of the cartilage graft, or recurrence of lower eyelid malpositions. Postoperatively, all lower eyelids moved downward with down-gaze. The auricular scar left no significant cosmetic deformity.
  
  
  CONCLUSIONS
  The modified auricular cartilage sling with 4 point fixation for paralytic ectropion appears to maintain normal eyelid mobility with down-gaze and avoids the problem of lower eyelid fixation.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: awatanab@mx5.canvas.ne.jp.
authors.forename: Akihide
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Department of Oculoplastic and Orbital Surgery, Seirei Hamamatsu Hospital, Shizuoka, Japan.
authors.forename: Nobutada
authors.initials: N
authors.lastname: Katori
authors.affiliation: Discipline of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
authors.affiliation: Department of Ophthalmology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods; D001763:Blepharoptosis / Q000601:surgery; D002921:Cicatrix / Q000517:prevention & control; D004425:Ear Cartilage / Q000637:transplantation*; D004483:Ectropion / Q000150:complications / Q000601:surgery*; D005143:Eyelids / Q000503:physiopathology / Q000601:surgery; D005158:Facial Paralysis / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D012008:Recurrence; D012189:Retrospective Studies; D013536:Suture Techniques; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome
keywords: Auricular cartilage; Lagophthalmos; Lower eyelid retractors; Margin reflex distance; Paralytic ectropion