Reconstruction of an inner layer defect of the upper eyelid with avulsion of the superior levator palpebrae muscle and orbital fat.

The authors report a successful reconstruction of the total upper eyelid in conjunction with the gliding surface of the extraocular muscles. A 21-year-old woman sustained an inner layer defect of her right upper eyelid together with avulsions of the superior levator palpebrae muscle and the superior orbital fat. Her right superior rectus muscle was exposed, and no orbital fat was seen in the space between the muscle and the orbital roof. To preserve eye movement, a gliding surface between the superior rectus muscle and the orbital roof had to be reconstructed. Total upper lid reconstruction was performed using a radial forearm flap with a hard palate mucosal graft. The gliding surface was reconstructed with an adipofascial flap obtained from the forearm. Despite lack of levator function, the patient could raise her eyelid approximately 5 mm by using only the superior rectus muscle without frontalis suspension.