Our Experience with the Masquerade Procedure for Total Eyelid Loss

• Published in: Orbit (Amsterdam) Vol. 29; no. 6; pp. 313 - 316
• Main Authors: Reilly, Philip O', Malhotra, Raman
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare 01.12.2010; Taylor & Francis
• Subjects: Blepharoplasty - methods; Corneal Diseases - prevention & control; Eyelids - injuries; Eyelids - surgery; Follow-Up Studies; Graft Survival; Humans; Injury Severity Score; Male; Masquerade; Middle Aged; Postoperative Care - methods; Procedure; Reconstructive; Reconstructive Surgical Procedures - methods; Risk Assessment; Surgical Flaps; Total eyelid loss; Wound Healing - physiology
• ISSN: 0167-6830; 1744-5108
• DOI: 10.3109/01676830.2010.510236

Purpose: To describe our experience of the Masquerade Procedure, a historical procedure that is poorly described in the modern literature. Methods: We performed a masquerade procedure in two complex surgical cases where traditional methods of eyelid reconstruction or closure were not possible. The first case suffered a partial de-gloving injury with a right sided anterior exenteration and loss of the upper and lower eyelids. On the left side, he lost the lower forehead and brow as well as the entire left upper eyelid leaving superior bulbar conjunctiva only. The cornea of the left eye was completely exposed and required urgent coverage. The second case was involved in a light aircraft crash and suffered extensive facial burns with periocular involvement bilaterally. On the left side, there was complete loss of the upper and lower eyelids and fornices extending to the bulbar conjunctiva. The cornea was keratinized and vascularised due to chronic exposure. Results: In the first patient, poor eyelid closure led to corneal ulceration and scarring. A repeat procedure involved the use of a cheek rotation flap, and ultimately the fashioning of a small port-hole aperture inferiorly to avoid corneal exposure. The patient maintains navigational vision. The second patient had two attempts at a masquerade procedure, however the poor blood supply led to complete and partial failure of the first and second procedures respectively. Conclusion: The masquerade procedure may be considered in extreme circumstances, however in our experience, multiple interventions and further reconstructive surgery may subsequently be required.