Copyright © 2018 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. Management of Severe Cicatricial Entropion With Labial Mucous Membrane Graft in Cicatricial Ocular Surface Disorders Tammy H. Osaki, MD, PhD, y Ana Estela Sant’Anna, MD, PhD,  Midori H. Osaki, MD, MBA, y Don O. Kikkawa, MD, FACS, z§ Cristina Yabumoto, MD,  Patrick Yang, MD, z and Bobby S. Korn, MD, FACS z§ Abstract: The management of cicatricial entropion represents a therapeutic challenge especially when the underlying causes are progressive cicatricial diseases that affect the ocular surface. The authors aimed to report long-term efficacy of labial mucous membrane graft to manage severe cicatricial entropion of the upper eyelid. This study is a retrospective chart review of patients who underwent tarsotomy associated with labial mucous membrane graft to treat severe cicatricial entropion of the upper eyelid. Surgeries were performed over a 16-year period. Clinical data (age, gender, etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recur- rence, complications, and follow-up period) were extracted from these patients’ charts. Etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, com- plications, and follow-up period were evaluated. Sixty-three eyelids from 44 patients underwent surgery. Mean follow-up was 48.4  46.1 months (range 6 months to 15 years). Main underlying diagnoses were Stevens–Johnson syndrome (63%), trachoma (19%), chemical injury (8%), and trauma (5%). Forty- three patients (98%) reported improvement of ocular symptoms after the procedure. Complete resolution (restoration of the upper eyelid margin to normal anatomic position with good esthetic appearance) was achieved in 52 eyelids (83%). Recur- rence occurred in 7 (11%) eyelids. No postoperative infection, failure of graft survival, or other complications were observed. The use of labial mucous membrane as a posterior lamella graft showed good functional and cosmetic outcomes, long-term stability and low recurrence rates in the treatment of severe cicatricial entropion of the upper eyelid. Key Words: Cicatricial entropion, ocular surface disease, oral mucous membrane, Stevens–Johnson syndrome, tarsotomy, trachoma (J Craniofac Surg 2018;00: 00–00) T he management of cicatricial entropion represents a therapeutic challenge, especially when the underlying causes are progres- sive cicatricial diseases that affect the ocular surface such as Stevens–Johnson syndrome (SJS) and trachoma. Various surgical procedures and variations have been described to treat this condition, including tarsotomy with margin rotation, 1–5 posterior lamella advancement, 6,7 anterior lamella recession, 8,9 tarsal wedge resections, 6,10 and posterior lamella lengthening using grafts, 11–17 with varied success rates depending on the severity of the entropion and the underlying cause. Oral mucous grafts have been used to treat several eyelid and ocular surface disorders. 17–23 The use of labial mucous membrane graft to lengthen the posterior lamella was first described by Hosni 17 in 1974. We report our experience using a modified technique to manage severe upper eyelid cicatricial entropion patients over a 16-year period. MATERIALS AND METHODS After institutional review board approval and informed consent was obtained, the surgical logs of 6 surgeons were reviewed to identify all patients who underwent tarsotomy associated with labial mucous membrane graft to treat severe upper eyelid cicatricial entropion between January 2001 and February 2017. Clinical data (age, gender, etiology of the cicatricial entropion, ocular symptoms, eyelid positioning, recurrence, and follow-up period) were extracted from these patients’ charts. All subjects were treated in accordance with the tenets of the Declaration of Helsinki. Only patients with severe cicatricial entropion on the upper eyelid, defined as ‘‘gross entropion with tarsal deformity and shortening associated with conjunctival scarring’’ by Kemp and Collin, 6 were included in this study. Patients with cicatricial margin entropion were excluded from this series. Surgical Technique The procedure described herein is a modification of the tech- nique described by Hosni 17 in 1974. All procedures were performed under local anesthesia with sedation, except for 2 patients (6- and 11-year-old patients), which were performed under general anesthesia. From the  Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Federal University of Sa ˜o Paulo, Paulista School of Medicine; y Osaki Ophthalmic Plastic Surgery, Sa ˜o Paulo, Brazil; z Division of Ophthalmic Plastic and Recon- structive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego School of Medicine; and § Division of Plastic Surgery, Department of Surgery, University of California, San Diego School of Medicine, La Jolla, CA. Received February 10, 2018. Accepted for publication March 6, 2018. Address correspondence and reprint requests to Midori H. Osaki, MD, MBA, Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Federal University of Sa ˜o Paulo, Paulista School of Medicine, Sa ˜o Paulo, SP, Brazil; Osaki Ophthalmic Plastic Surgery, Vergueiro St, 2045 St 1009, Sa ˜o Paulo, SP, Brazil 04101-000; E-mail: midori_osaki@yahoo.com.br The authors report no conflicts of interest. Copyright # 2018 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000004584 ORIGINAL ARTICLE The Journal of Craniofacial Surgery  Volume 00, Number 00, Month 2018 1