Indian Journal of Ophthalmology

CASE REPORT
Year
: 1988  |  Volume : 36  |  Issue : 1  |  Page : 32--33

Lid reconstruction for kissing naevus


SM Betharia, S Kumar 
 Dr. RP. Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi-I 10 029, India

Correspondence Address:
S M Betharia
Dr. RP. Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi-I 10 029
India

Abstract

Repair of colobomas caused after excision of kissing naevi presents a special problem because of their symmetrical placement. Successful repair in two cases with the surgical-technique is presented. Canthotomy and cantholysis along with direct suturing and Tenzel«SQ»s semicircular rotation flap gave excellent results.



How to cite this article:
Betharia S M, Kumar S. Lid reconstruction for kissing naevus.Indian J Ophthalmol 1988;36:32-33


How to cite this URL:
Betharia S M, Kumar S. Lid reconstruction for kissing naevus. Indian J Ophthalmol [serial online] 1988 [cited 2020 Jan 23 ];36:32-33
Available from: http://www.ijo.in/text.asp?1988/36/1/32/26167


Full Text

 Introduction



Kissing naevus is a congenital a nomaly of the lids involving both the lids at the same position. [1] Some of these lesions are quite big in size and involve almost half of both the lids. [2],[3] The excision and repair is required both for cosmetic reasons and also to rule out the chances of malignant melanoma of the lid [4] Since the lesions are involving both the lids at symmetrical sites reconstruction poses a problem. We are presenting 2 such cases wherein successful lid reconstruction was performed by cantholysis and direct suturing and by use of Tenzels' semicircular flap operation.

 Case report



Case 1 : A 35 year old male, presented with pigmented growth symmetrically placed in both the lids of the left eye. The mass was gradually increasing in size since birth. It measured 20 mm x 15 mm in the upper lid and 15 mm x 30 mm in the lower lid. The colour was brownish black and the surface irregular. It was invol­ving the conjunctival side also, but spared the lacrimal puncta of both the lids.

Case 2 : A 18 years old boy presented with pigmented growth on both lids since birth but increasing in size for the last 1 year. The lesiur measured about 15 mm x 10 mm in both the lids. The lesion was brownish black and surface was irregular. The cilia were absent over the lesion

 Surgical steps



In case no. I though the lesions were involving nearly half of both the lids [Figure 1] laxity of the tissue was present The canthotomy and cantholysis were done and lid repair in both the lids was carried out by the direct suturing method [Figure 2]. The mattress suture was first passed at the grey line and two more mattress sutures were padded one anterior and one posterior to the grey line. The sutures were so tightened that a pouting of the lid margin was achieved on the table. The tarso­conjunctival lamina was stitched with 5-0 chromic catgut and skin muscle lamina with black silk.

Case 2 : This patient being young there was no laxity of the lid [Figure 3]. The lesion was excised under frozen section control and reconstruction was carried out Tenzel's semicircular flap was made. The incision was taken from the lateral canthus going downwards upto the level of the cheek and was brought upwards in a curved manner. Cantholysis was done and after comp­lete mobilisation of the flap repair was carried in two layers, that is tarso- conjunctiva with 5-0 chormic catgut and the skin muscle lamina with black silk [Figure 4].

The lower part of the defect was made triangular with the medial limb straight Some portion of the mobilized skin muscle flap was excised to achieve correct opposi­tion. The flap was anchored deeply to the periosteum to prevent sagging of the lid The lower lid repair was easier in this case. The mass was excised keeping the tarso­conjunctival lamina intact as the lesion was not deep. The skin muscle lamina was mobilized from below and continuous 6-0 black silk sutures were passed.

 Discussion



Large number of methods are described from time to time depending upon the amount of lid tissue involved Most of these methods deal with reconstruction of coloboma of one lid The situation is very different in kissing naevus where we are forced with a problem of repair of symmetrically placed colobomas of both lids Obviously the time tested methods like Cutler Beard technique [5] and Hughes [6] technique are of no avail for the repair, in case of kissing naevus. Therefore, use of some form of direct suturing with canthotomy and cantholysis for mobilising the lid tissue along with Tenzel's [8] semi­circular flap operation for the upper lid give good results. Proper mobilization and rotation of Tenzel's flap and its suturing avoiding the dog ear deformity is extremely important[9].

References

1Fuchs, A Klin. Mbl, Augenheilk, 63:678, 1919.
2Callahan, A Am J. Ophthalmol 29: 563, 1946
3Ehlers, N.: Arch. Ophthalmol., 73: 664, 1965:
4Reese, A.B. Am. J. OphthalmoL 61 :1272, 1966.
5Cutler, N.L and Beard C. Amer. J. Ophthalmol.
6Cutler, N.L and Beard, G Amer. J. Ophthalmol. 39: 1, 1955
7Huges, W.L Arch Ophthalmol., 17:1008,1937
8Reeh, M.J., Beyer, GK and Shannon; G.M. Practical Ophthalmic plastic and reconstructive surgery. Lea and Febiger, Philadelphia, pg 46, 1976.
9Tenzel, RR Arch. Ophthalmol, 93: 125, 1975.