Auricular Cartilage Grafting for Lower-Eyelid Entropion in Syndromic Craniosynostosis: A Case Series

Patients with syndromic craniosynostosis, including Crouzon and Pfeiffer syndromes, may develop lower-eyelid malposition, including retraction and secondary entropion, associated with complex midfacial and orbital anatomical abnormalities. Progressive midface hypoplasia, shallow orbits, and postoperative anatomical changes following craniofacial surgery may contribute to imbalance between the anterior and posterior lamellae, relative posterior lamellar insufficiency, and persistent eyelash-corneal contact. We report a retrospective case series of 3 patients who underwent posterior lamellar lengthening using autologous auricular cartilage grafts via a transconjunctival approach. The harvested cartilage was secured to the tarsal plate to increase posterior lamellar height and correct lower-eyelid entropion. All patients experienced improvement in cilia-corneal touch and symptomatic relief, with satisfactory functional and aesthetic outcomes. No recurrence or major complications were observed during follow-up. Auricular cartilage grafting may represent a useful surgical option for selected patients with lower-eyelid entropion associated with syndromic craniosynostosis, particularly in patients with severe midface hypoplasia or previous midface advancement procedures.