Complex Eyelid Neurofibroma Excision-Step by Step Surgery This video demonstrates the surgical resection of plexiform neurofibroma of eyelid along with eyelid reconstruction.
The horizontal eyelid length is first marked comparing with the other side .Then the eyelid crease is marked by comparing with other side .The excess periorbital tissue is marked in an elliptical manner . The excess full thickness eyelid is marked as a pentagon on the lateral side of the eyelid.
Local infiltration is given with lignocaine with adrenaline. Lid traction sutures are taken with 5-0 mersilk.
The lid crease incision is taken and the neurofibromatous tissue is debulked. Generally this tumour bleeds more during surgery due to the presence of immature vessels within the tumour .Lateral pentagon full thickness eyelid tissue is then excised. This excision can have differential removal of the anterior and posterior lamella. The periorbital ellipse is then excised .Sub conjunctival lignocaine injection is used to dissect the tumour tissue from the conjunctiva. In this patient the neurofibromatous tissue was present posterior to the levator too. The levator muscle was separated from the tumour tissue both anteriorly as well as posteriorly. The horizontal eyelid length is again verified before complete excision of the lateral pentagon. Once the levator dissection is complete, the lateral horn is cut followed by the medial horn. The neurofibromatous tissue posterior to the levator is seen here. Excess post lamella including tarsus and conjunctiva along with tumour tissue is excised after marking. The cut edges are sutured with 6-0 vicryl.Three horizontal mattress sutures are taken on the levator at the desired height and passed through the tarsus. The lid height and contour are checked by asking the patient to look straight. Once the desired height and contour is achieved the excess levator is excised and the sutures are finalized. A strip is fashioned at the lateral end of the tarsus and is anchored to the periosteum at the supero lateral orbital margin with 5-0 prolene mattress suture. The periorbital incision is closed with 5-0 vicryl and 6-0 prolene in two layers. Debulking is completed. Lateral canthal forming suture is then taken with 5-0 prolene . Excess skin is excised near the lid crease. Lid crease forming sutures are taken by including the levator in the skin bites. Lower lid frost suture is taken which is retained for 24 – 48 hours post op.