1
|
Park JK, Campbell B, Shipchandler T, Lee HBH. Outcome Comparison of Transconjunctival Müller's Muscle Recession With Levator Disinsertion (TMRLD) to Gold Weight Implantation in the Treatment of Paralytic Lagophthalmos. Ophthalmic Plast Reconstr Surg 2024; 40:326-330. [PMID: 38215464 DOI: 10.1097/iop.0000000000002582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE To compare clinical outcomes of transconjunctival Müller's muscle recession with levator disinsertion (TMRLD) to the traditional gold weight implantation in patients with paralytic lagophthalmos. METHODS A retrospective nonrandomized comparative review of patients who had gold weight implantation and TMRLD surgeries for paralytic lagophthalmos from January 2016 to January 2023 was performed. The main outcome comparisons were measurement changes in lagophthalmos, marginal reflex distance 1, visual acuity, and corneal examination. Complication and reoperation rates were also compared. RESULTS Twenty-six cases of gold weight implantation and 20 cases of TMRLD surgeries were identified. The changes in logMAR visual acuity between gold weight implantation and TMRLD groups were not statistically significant (-0.10 ± 0.48 vs. +0.05 ± 0.14, p > 0.05). The percent improvement in lagophthalmos (62.2% ± 51.8% vs. 58.4% ± 21.1%) and final marginal reflex distance 1 (2.22 ± 1.42 vs. 2.25 ± 1.41 mm) were also comparable between groups ( p > 0.05). Both groups showed similar changes in marginal reflex distance 1 (1.75 ± 1.31 vs. 2.83 ± 1.37 mm) and lagophthalmos (3.77 ± 3.92 vs. 3.36 ± 1.36 mm) ( p > 0.05). The overall complication (15.4% vs. 15.0%) and reoperation rates (15.4% vs. 15.0%) were comparable over the follow-up duration (291.6 ± 437.3 vs. 121.0 ± 177.8 days) ( p > 0.05). CONCLUSION TMRLD is as safe and effective as the gold weight implantation in addressing paralytic lagophthalmos in patients with facial nerve palsy.
Collapse
Affiliation(s)
- Ji Kwan Park
- Oculofacial Plastic and Orbital Surgery, Carmel, Indiana, U.S.A
- Ascension St. Vincent Hospital, Indianapolis, Indiana, U.S.A
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | | | - Taha Shipchandler
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Hui Bae Harold Lee
- Oculofacial Plastic and Orbital Surgery, Carmel, Indiana, U.S.A
- Ascension St. Vincent Hospital, Indianapolis, Indiana, U.S.A
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| |
Collapse
|
2
|
Ng CY, Yong GY, Ngai JJ, Zainal-Abidin Z. A rare diagnosis of nine syndrome: Clinical, imaging findings, and literature review. Taiwan J Ophthalmol 2023. [DOI: 10.4103/tjo.tjo-d-22-00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
3
|
Combined Dermis Spacer Graft, Lateral Canthopexy and Subperiosteal Midface Lifting in the Management of Lower Eyelid Retraction Secondary to Chronic Facial Nerve Palsy. J Maxillofac Oral Surg 2022. [DOI: 10.1007/s12663-022-01688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
4
|
Galindo-Ferreiro A, Marqués-Fernández V, Sanchez-Tocino H, Schellini SA. Objective assessment of eyelid position and tear meniscus in facial nerve palsy. Orbit 2021; 41:700-707. [PMID: 34958290 DOI: 10.1080/01676830.2021.1992789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate lower lid position and tear meniscus in peripheral idiopathic facial nerve palsy (FNP). METHODS A prospective study enrolled patients with peripheral idiopathic FNP and epiphora. Data were collected on patient demographics, House-Brackmann (HB) scale, digital photographs of the face, and tear meniscus at the 1st, 30, and 90 day after onset of FNP. Marginal reflex distance to the upper (MRD1) and lower eyelid (MRD2) were evaluated using ImageJ software. Anterior segment optical coherence tomography (OCT) was performed to measure the tear menis- cus. P< .05 was considered statistically significant. RESULTS Sixteen patients were evaluated. The HB scale at presentation was grade III in six patients (37.5%). At 90 day, nine patients (56.25%) were grade I-normal. Three (18.7%) had upper lid retraction, three (18.7%) upper eyelid asymmetry and 7 (43.75%), lower eyelid retraction. The difference between MRD2-FNP with MRD2-healthy side was 0.51 ± 1.9 mm at the 1st visit, decreasing to 0.09 ± 1.47 mm at 90 days (P= .877). Tear meniscus measurements were significantly higher in FNP at the 1st visit (P= .001). The decrease in MRD2 was statistically correlated with the reduction of the tear meniscus area (TMA) (r = 0.67; P= .007) at 90 days. No correlation was found between HB and TMA. There is a difference in TMA between age groups at the 1st day(p= .009). Eldest group had higher HB scales. CONCLUSION Quantitative evaluation of eyelid position and tear meniscus are effective to document the evolution of FNP and can serve as a clue of orbicularis recovery.
Collapse
Affiliation(s)
| | | | | | - Silvana A Schellini
- Department of Ophthalmology, Medical School, State University of São Paulo - UNESP - University Campus, São Paulo, Brazil
| |
Collapse
|
5
|
Karlin JN, Farajzadeh J, Stacy S, Esfandiari M, Rootman DB. The Effect of Zero Gravity on Eyelid and Brow Position. Ophthalmic Plast Reconstr Surg 2021; 37:592-594. [PMID: 33710037 DOI: 10.1097/iop.0000000000001961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the effect of spaceflight on upper eyelid and brow position. MATERIALS AND METHODS Images of astronauts on earth and in space were collected from a National Aeronautics and Space Administration image library. For each astronaut, front facing portraits captured within a 5-year period were obtained. At least 6 photos were collected per astronaut, 3 taken on earth, and 3 in zero gravity. Measurements from the center of the pupil to the upper eyelid margin (MRD1) and center of the pupil to the inferior eyebrow margin [pupil-to-brow (PTB)] were performed digitally for each image and averaged for each condition and each individual. Differences in mean MRD1 and PTB were assessed to illustrate the effects of zero gravity on eyelid and eyebrow position respectively. Linear-mixed effects modeling, analysis of variance and post hoc power analysis were performed. RESULTS One hundred and twelve photographs (55 earth, 57 space) from 18 astronauts (4 women, 14 men; mean age 45.9 years) were retrieved. Zero gravity resulted in a mean PTB increase of 3.7 mm (p < 0.01) but did not result in significant change in MRD1 (p = 0.21). Post hoc power analysis of the measured MRD1 difference was performed by simulation. At an MRD1 difference of 0.5 mm, the probability of a type II error is 2.6%, equivalent to a beta power of 97.4%. Thus, we can be 97.4% confident that a difference in MRD of 0.5 mm or greater would be detected. CONCLUSIONS While spaceflight led to significant elevation of PTB, it did not consistently alter MRD1. As such, the brow and eyelid appear to be independently regulated with respect to gravitational changes.
Collapse
Affiliation(s)
- Justin N Karlin
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California
| | | | - Stephanie Stacy
- Department of Statistics, University of California, Los Angeles, CA
| | | | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California
| |
Collapse
|
6
|
Cohen LM, Rootman DB. Blepharoptosis Repair: External Versus Posterior Approach Surgery: Why I Select One over the Other. Facial Plast Surg Clin North Am 2021; 29:195-208. [PMID: 33906756 DOI: 10.1016/j.fsc.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ptosis surgery is performed via an anterior/external or posterior/internal approach, primarily defined by the eyelid elevator muscle surgically addressed: the levator complex anteriorly or Muller muscle posteriorly. Posterior ptosis surgery via Muller muscle conjunctival resection is an excellent first choice for cases of mild to moderate ptosis with good levator function, as it is predictable, provides a reliable cosmetic outcome, requires no patient cooperation during surgery, portends a lower rate of reoperation, and rarely leads to lagophthalmos and/or eyelid retraction postoperatively. External levator resection is preferred in patients with severe ocular surface/cicatricial conjunctival disease, shortened fornices, and lesser levator function.
Collapse
Affiliation(s)
- Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California Los Angeles, Los Angeles, 300 Stein Plaza, Los Angeles, CA 90095, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California Los Angeles, Los Angeles, 300 Stein Plaza, Los Angeles, CA 90095, USA.
| |
Collapse
|
7
|
Heydenrych I. The Treatment of Facial Asymmetry with Botulinum Toxin: Current Concepts, Guidelines, and Future Trends. Indian J Plast Surg 2020; 53:219-229. [PMID: 32884188 PMCID: PMC7458832 DOI: 10.1055/s-0040-1715189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This article will describe facial asymmetry secondary to facial nerve paralysis (FNP), and review current concepts, guidelines, and future trends. Despite the increasing use of botulinum toxin (BoNTA) in treating FNP, ideal dosage, timing, and additional therapies are not unequivocally established. Facial asymmetry significantly impacts quality of life (QOL) by strongly affecting self-perception and social interactions; injectables may mediate great clinical improvement. This article provides practical guidelines for the use of BoNTA and provides schemes for accurate assessment and documentation. A systematic, stepwise approach is recommended with methodical assessment, meticulous placement, conservative dosage, and careful follow-up. Future trends include the potential use of newly developed toxins, muscle modification with fillers, improved imaging techniques, and targeted QOL studies. Hopefully, a growing number of aesthetic injectors may become technically proficient and join multidisciplinary teams for managing FNP.
Collapse
Affiliation(s)
- Izolda Heydenrych
- Department of Dermatology, Cape Town Cosmetic Dermatology Centre, Central Park on Esplanade, Century City, Cape Town, South Africa
| |
Collapse
|
8
|
Lee S, Lew H. Ophthalmologic Clinical Features of Facial Nerve Palsy Patients. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:1-7. [PMID: 30746906 PMCID: PMC6372383 DOI: 10.3341/kjo.2018.0010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To understand the ophthalmic clinical features and outcomes of facial nerve palsy patients who were referred to an ophthalmic clinic for various conditions like Bell's palsy, trauma, and brain tumor. METHODS A retrospective study was conducted of 34 eyes from 31 facial nerve palsy patients who visited a clinic between August 2007 and July 2017. The clinical signs, management, and prognosis were analyzed. RESULTS The average disease period was 51.1 ± 20.6 months, and the average follow-up duration was 24.0 ± 37.5 months. The causes of facial palsy were as follows: Bell's palsy, 13 cases; trauma, six cases; brain tumor, five cases; and cerebrovascular disease, four cases. The clinical signs were as follows: lagophthalmos, 24 eyes; corneal epithelial defect, 20 eyes; conjunctival injection, 19 eyes; ptosis, 15 eyes; and tearing, 12 eyes. Paralytic strabismus was found in seven eyes of patients with another cranial nerve palsy (including the third, fifth, or sixth cranial nerve). Conservative treatments (like ophthalmic ointment or eyelid taping) were conducted along with invasive procedures (like levator resection, tarsorrhaphy, or botulinum neurotoxin type A injection) in 17 eyes (50.0%). Over 60% of the patients with symptomatic improvement were treated using invasive treatment. At the time of last following, signs had improved in 70.8% of patients with lagophthalmos, 90% with corneal epithelium defect, 58.3% with tearing, and 72.7% with ptosis. The rate of improvement for all signs was high in patients suffering from facial nerve palsy without combined cranial nerve palsy. CONCLUSIONS The ophthalmic clinical features of facial nerve palsy were mainly corneal lesion and eyelid malposition, and their clinical course improved after invasive procedures. When palsy of the third, fifth, or sixty cranial nerve was involved, the prognosis and ophthalmic signs were worse than in cases of simple facial palsy. Understanding these differences will help the ophthalmologist take care of patients with facial nerve palsy.
Collapse
Affiliation(s)
- Seunghyun Lee
- Department of Ophthalmology, CHA Bundang Medical Center, Seongnam, Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, Seongnam, Korea.
| |
Collapse
|
9
|
Singhdev J, Asranna A, Sureshbabu S, Mittal GK, Singla S, Peter S, Chindripu S. Nine Syndrome: Case Report and Review of Clinical Signs in Internuclear Ophthalmoplegia. Ann Indian Acad Neurol 2018; 21:325-327. [PMID: 30532368 PMCID: PMC6238551 DOI: 10.4103/aian.aian_118_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The pathologic involvement of brainstem and midbrain nuclei and white matter tracts in various combinations may result in a spectrum of arithmetically derived syndromes. They include ‘one and a half syndrome’, ‘eight and a half syndrome’ and ‘fifteen and a half syndrome’. We report a case of ‘nine syndrome’, which has been reported more recently, caused by caused by acute pontine infarcts and characterised clinically by a combination of internuclear ophthalmolplegia, ipsilateral horizontal gaze palsy, lower motor neuron type of facial palsy, contralateral hemiparesis and hemianesthesia. We highlight the genesis of this combination of clinical signs, revisit the different variants of INO and review the literature on ‘Nine syndrome’.
Collapse
Affiliation(s)
| | - Ajay Asranna
- Department of Neurology, St. Stephen's Hospital, New Delhi, India
| | | | | | - Sweta Singla
- Department of Neurology, St. Stephen's Hospital, New Delhi, India
| | - Sudhir Peter
- Department of Pathology, Medall Healthcare, Ongole, Andhra Pradesh, India
| | - Sobhana Chindripu
- Department of Pathology, Guntur Medical College, Andhra Pradesh, India
| |
Collapse
|
10
|
Kim IA, Wu TJ, Byrne PJ. Paralytic Lagophthalmos: Comprehensive Approach to Management. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0219-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Predictors of Success Following Müller’s Muscle-Conjunctival Resection. Ophthalmic Plast Reconstr Surg 2018; 34:483-486. [DOI: 10.1097/iop.0000000000001065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Change in Eyelid Position Following Muller's Muscle Conjunctival Resection With a Standard Versus Variable Resection Length. Ophthalmic Plast Reconstr Surg 2018; 34:355-360. [PMID: 28914711 DOI: 10.1097/iop.0000000000000997] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study compares the use of a standard 7 mm resection length to a variable 4:1 ratio of resection length to desired elevation nomogram when performing Muller's muscle conjunctival resection surgery. METHODS In this cross-sectional case control study, 2 groups were defined. The first underwent Muller's muscle conjunctival resection surgery with a standard 7 mm resection length and the second underwent the same surgery with a variable resection length determined by a 4:1 ratio of resection length to desired elevation nomogram. Groups were matched for age (within 5 years) and sex. Pre- and postoperative photographs were measured digitally. Change in upper marginal reflex distance 1 (MRD1) and final MRD1 were the primary outcome measures. The study was powered to detect a 1 mm difference in MRD1 to a beta error of 0.95. RESULTS No significant preoperative differences between the groups were noted. No significant difference in final MRD1 (0.1 mm; p = 0.74) or change in MRD1 (0.2 mm; p = 0.52) was noted. Mean resection length to elevation ratios were 3.9:1 for standard group and 4.3:1 for the variable group (p = 0.54). CONCLUSION The authors were not able to detect a significant difference in final MRD1 or change in MRD1 for patients undergoing Muller's muscle conjunctival resection surgery with standard or variable resection lengths. These results tend to argue against a purely mechanical mechanism for Muller's muscle conjunctival resection surgery.
Collapse
|
13
|
Assessing the Accuracy of Eyelid Measurements Utilizing the Volk Eye Check System and Clinical Measurements. Ophthalmic Plast Reconstr Surg 2018; 34:346-350. [DOI: 10.1097/iop.0000000000000991] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
|