[Transplants from the hard palate: method for mucosal graft reconstruction of the upper eyelid].

BACKGROUND: Mucosal grafts from the hard palate for reconstruction of the posterior lamella of the upper eyelid were compared for three different indications. The plastic reconstruction of the upper eyelid was carried out in patients with symblepharon and upper eyelid entropion following an autoimmune disease, in patients with subtotal or total upper eyelid resection due to a neoplasm and in patients with mucous membrane trauma using autogenous mucosal grafts from the hard palate. PATIENTS: In this retrospective comparative interventional case series 23 eyes from 19 patients were included in whom upper eyelid reconstruction was undertaken at the University Eye Hospital in Salzburg between 2001 and 2012. Reconstruction with hard palate grafts was performed in 5 eyes following extensive tumor resection, in 5 eyes of 3 patients after autoimmune diseases and in 13 eyes of 11 patients following trauma rehabilitation.
RESULTS: In the total collective of patients who underwent upper eyelid reconstruction with hard palate grafts, no graft rejection or loss of graft occurred. Hard palate grafts are useful for reconstruction after tumor surgery in addition to other techniques in order to achieve good functional and esthetic results. For patients suffering from autoimmune disease (e.g. ocular pemphigus and Stevens-Johnson syndrome) the use of hard palate grafts was found to be equally useful, although results can possibly deteriorate over time due to the underlying disease. Hard palate grafts were shown to be very useful in reconstruction of the upper eyelid for correction of entropium due to symblepharon and distichiasis following thermal and chemical burns.
CONCLUSION: Hard palate grafts are suitable as mucosal grafts replacing conjunctiva in systemic disease and are equally effective in the treatment of traumatic upper eyelid defects - such as defects after tumor surgery.