View 2019 Abstracts

Fornix and socket reconstruction can be a challenge, regardless as to whether the cause is socket contraction or cicatrising disease. Options for large grafts with other than oral mucosa are limited and difficult to obtain.
Periosteal flaps have been used for lid reconstruction, they conjunctivalise well and are friendly to the ocular surface. Periosteum is a readily available at any size required and its donor site is relatively painless in the postoperative period.
We describe the use of periosteum as a graft for fornix reconstruction and report our results.

We report a retrospective case series of three patients undergoing fornix reconstruction with use of periosteal grafts. Patients were aged 12, 42 and 77 years old, with indications of fire work injury, mucus membrane pemphigoid and chemical injury respectively.
All patients had previously undergone buccal mucosa grafting unsuccessfully, and had now contra-indication for the use of our routinely preferred method of using oral mucosal grafts.

All patients underwent harvesting of periosteal flaps from the crown of their head or superiorly on the forehead as part of the harvest of a pericranial flap. There were no harvest site related discomfort affecting daily activities.
Graft sizes of 4-5 cm were utilised, but could easily be sized up if required.
All patients had deepening of their fornices, with the inferior fornix improving more than the superior fornix.
Patients were comfortable post-operatively but all had significant swelling that took more than 6 weeks to resolve.
The first (paediatric) patient developed an infectious keratitis, possibly related to the use of a bolster. In the remaining cases, a fornix deepening bolster was not used.

We present our experience with periosteal grafts for posterior lamella replacement and fornix reconstruction. Periosteum can be considered as an alternative to oral mucous membrane in selected cases. Peri-operative antibiotics and possibly, corticosteroids may be of value in these cases. The risks and benefits of bolsters are debatable.