Reconstruction of Full-Thickness Lower Lid Defects Using Texier's Procedure: Retrospective Assessment of the Indications

Purpose: Lower lid defects involving more than 75% of the lid's length or affecting the cheek are usually reconstructed with a Mustarde rotational cheek flap. This solution often induces postoperative ectropion. The Texier procedure (an upper lid myocutaneous flap and a chondromucosal alar graft) is usually indicated for 1-step reconstruction of full-thickness defects involving less than 50% of the lower lid. This retrospective study evaluated larger indications for the Texier procedure for full-thickness defects of the lower lid, results of lid defects longer than 50 or even 75%, and the use of a chondromucosal nasal septal graft for lid defects longer than 75%. Materials and Methods: All lower lid reconstructions using the Texier procedure over a period of 29 months were retrospectively included. Data on postoperative complications and patient satisfaction were collected. Results: Fifteen patients were included; one third had a defect involving no more than 50% of the lower lid, one third presented with a defect of 50 to 75%, and one third had a defect of at least 75%. In this last group, reconstruction included a septal graft. Mean follow-up was 35 months. Transitory palpebral edema was present in 100% of patients and lasted 8 months on average. No postoperative ectropion or nasal alar retraction of the graft donor site was observed. Mean satisfaction score was 2.86 of 3. Conclusions: The Texier procedure can be used as first-line treatment to reconstruct most full-thickness defects of the lower lid, including subtotal defects. (C) 2018 American Association of Oral and Maxillofacial Surgeons