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Barros VPO, Chaves ILC, Meneghim RLFS, Padovani CR, Schellini SA. Cerclage sling technique using temporalis muscle fascia to manage paralytic lagophthalmos: A preliminary study. J Fr Ophtalmol 2024; 47:104094. [PMID: 38382275 DOI: 10.1016/j.jfo.2024.104094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE Despite various existing surgical techniques, treatment of facial nerve palsy remains difficult. The purpose of this report is to present the cerclage sling technique using temporalis fascia to manage paralytic lagophthalmos. METHODS A series of six patients underwent a cerclage sling technique using temporalis muscle fascia to treat paralytic lagophthalmos. The technique is presented in detail. Symptoms, palpebral fissures, and lagophthalmos were assessed pre- and postoperatively. Data were submitted for statistical analysis. RESULTS After surgery, all patients achieved a reduction in clinical symptoms. The upper eyelids had lowered, and the inferior eyelids had elevated, reducing ocular exposure even if mild residual lagophthalmos was present. CONCLUSION Cerclage using the temporalis muscle fascia sling technique is a safe and effective procedure to treat facial nerve paralytic lagophthalmos. A reduction in ocular exposure and lagophthalmos provides improvement in clinical symptoms and eyelid function.
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Affiliation(s)
- V P O Barros
- Ophthalmology Department, Medical School of State University of Sao Paulo - UNESP, Botucatu, 18618-970, São Paulo State, Brazil
| | - I L C Chaves
- Ophthalmology Department, Medical School of State University of Sao Paulo - UNESP, Botucatu, 18618-970, São Paulo State, Brazil
| | - R L F S Meneghim
- Ophthalmology Department, Medical School of State University of Sao Paulo - UNESP, Botucatu, 18618-970, São Paulo State, Brazil
| | - C R Padovani
- Biostatistics Department, Bioscience Institute of State University of Sao Paulo - UNESP, Botucatu, Brazil
| | - S A Schellini
- Ophthalmology Department, Medical School of State University of Sao Paulo - UNESP, Botucatu, 18618-970, São Paulo State, Brazil.
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Dhooghe N, Brusselle M, Ureel M, Sinove Y, Vermeersch H, Blondeel P. The effect of various muscle transfer procedures on eye closure and blinking in longstanding facial palsy patients. J Plast Reconstr Aesthet Surg 2024; 89:57-71. [PMID: 38142623 DOI: 10.1016/j.bjps.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/01/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Facial palsy causes paralytic lagophthalmos, which remarkably deteriorates a patient's quality of life. In cases where denervation time is over 18-24 months (longstanding facial palsy), a free or pedicled muscle transfer is needed to replace the denervated orbicularis oculi muscle. PURPOSE The purpose of this systematic review is to investigate the effect of various eye sphincter substitution procedures (free or pedicled muscle transfers) in longstanding facial palsy patients on eye closure and blink. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic review of the Embase, Medline, Web of Science and Cochrane Library databases and Google Scholar. Our literature search yielded 4322 articles. Following a full-text review, 4 retrospective cohort studies and 21 case series were selected for this review. Meta-analyses using R package meta (version 6.5-0) were conducted. MAIN FINDINGS All free and pedicled muscle transfers in this review showed an improvement in the scores and measurements on eye closure and blink. The pedicled temporalis muscle transfer was the procedure most commonly performed as eye reanimation surgery and showed consistent good results. Using the random effects model, the pooled effect of mean difference in lagophthalmos after gentle eye closure post-operatively versus pre-operatively (mm) in patients who received a pedicled (temporalis) muscle transfer was -6.19 (I2 = 85%, 95% CI: -7.89; -4.49) whereas it was -4.11 (I2 = 85%, 95% CI: -7.26; -0.95) for free (gracilis or platysma) muscle transfers. The pooled proportion of patients with complete eye closure after surgery was 0.69 (I2 = 49%, 95% CI: 0.54; 0.82) in patients who received a pedicled (temporalis) muscle transfer and 0.40 (I2 = 74%, 95% CI: 0.13; 0.74) in patients who received a free (platysma) muscle transfer. CONCLUSIONS Unlike smile reanimation, dynamic eye closure and blink restoration are rather neglected topics in facial reanimation. The pedicled temporalis muscle transfer is often recommended as the first treatment of choice for eye reanimation in longstanding facial palsy patients since it is a reliable, straightforward procedure, that does not require complex microsurgery. However, with the advancements in the field of microsurgery, free muscle transfers are promising therapies, which may regenerate voluntary and spontaneous blinking.
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Affiliation(s)
- Nicolas Dhooghe
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Belgium Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Marie Brusselle
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Belgium Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Medical Informatics, Erasmus MC Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Matthias Ureel
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Belgium Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Yves Sinove
- Department of Plastic, Reconstructive and Aesthetic Surgery, General Municipal Hospital Aalst, Merestraat 80, 9300 Aalst, Belgium
| | - Hubert Vermeersch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Belgium Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Phillip Blondeel
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Belgium Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Shokri T, Patel S, Weller C, Lighthall JG. A Surgeon's Armamentarium for Ocular Management in Facial Paralysis: A Comprehensive Review. J Craniofac Surg 2023; 34:214-21. [PMID: 36608099 DOI: 10.1097/SCS.0000000000009089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/04/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To review the current management paradigm of the eye in patients with facial paralysis. METHODS A PubMed and Cochrane search was done with no date restrictions for English-language literature on facial synkinesis. The search terms used were "ocular," "facial," "synkinesis," "palsy," "neurotization," and various combinations of the terms. A total of 65 articles were included. RESULTS Facial paralysis may result in devastating ocular sequelae. Therefore, assessment of the eye in facial paralysis is a critical component of patient management. Although the management should be individualized to the patient, the primary objective should include an ophthalmologic evaluation to implement measures to protect the ocular surface and preserve visual acuity. The degree of facial paralysis, lacrimal secretion, corneal sensation, and position of the eyelids should be assessed thoroughly. Patients with the anticipated recovery of facial nerve function may respond to more conservative temporizing measures to protect the ocular surface. Conversely, patients with expected prolonged paralysis should be appropriately identified as they will benefit from surgical reconstruction and rehabilitation of the periorbital complex. The majority of reconstructive measures within a facial surgeon's armamentarium augment coverage of the eye but are unable to restore blink. Eyelid reanimation restores the esthetic proportionality of the eye with blinking and reestablishes protective functions necessary for ocular preservation and function. CONCLUSIONS Ocular preservation is the primary priority in the initial management of the patient with facial paralysis. An accurate assessment is a critical component in identifying the type of paralysis and developing an individualized treatment plan.
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Staples JW, Zuker RM, Borschel GH. Transfer of the deep temporal nerve for eyelid reconstruction in Mobius syndrome - an anatomic feasibility study and proposed surgical approach. J Plast Reconstr Aesthet Surg 2021; 75:265-270. [PMID: 34305023 DOI: 10.1016/j.bjps.2021.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
Facial paralysis may result in significant functional, esthetic, and psychological morbidity. Mobius syndrome is a form of bilateral congenital facial paralysis that is particularly difficult to treat owing to the lack of readily available donor nerves, particularly in the upper face. In this study, we evaluate the feasibility of using the deep temporal nerves as donors for the innervation of free muscle grafts in the periorbital region. Preserved and fresh cadaver facial halves are dissected, and the course of the deep temporal nerves delineated. We find the middle branch of the deep temporal nerve to be located consistently 4.6 cm from the posterior edge of the tragus along the zygomatic arch, giving an easily identifiable surface landmark for our donor. Finally, we outline a proposed surgical approach for using the middle deep temporal nerve to innervate a free muscle graft to the eyelids through an interpositional nerve graft.
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Affiliation(s)
- John W Staples
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Division of Plastic and Reconstructive Surgery, University of Toronto, 555 University Avenue, Toronto ON, Canada M5G 1 × 8.
| | - Ronald M Zuker
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Division of Plastic and Reconstructive Surgery, University of Toronto, 555 University Avenue, Toronto ON, Canada M5G 1 × 8
| | - Gregory H Borschel
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Division of Plastic and Reconstructive Surgery, University of Toronto, 555 University Avenue, Toronto ON, Canada M5G 1 × 8
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Wong M, Ozaki M, Kurita M, Ihara A, Iwashina Y, Takushima A. Soft Tissue Reconstruction and Facial Reanimation With Bilateral Latissimus Dorsi Flaps After Extensive Resection of Head and Neck Arteriovenous Malformation: A Case Report. Ann Plast Surg 2019; 83:73-7. [PMID: 31135509 DOI: 10.1097/SAP.0000000000001878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a rare case of a 37-year-old man who presented with a huge arteriovenous malformation in the head and neck region. After resection, the 30 × 25 cm defect was reconstructed with a preexpanded musculocutaneous latissimus dorsi flap. The facial nerve had to be sacrificed during the resection, and smile reanimation was restored in a second operation with the contralateral latissimus muscle flap. A 15-cm length of thoracodorsal nerve was dissected and was anastomosed to the contralateral zygomatic branch in a single stage. He recovered well without any significant complications. At 6 years follow-up, there was no further growth of the arteriovenous malformation, and he had a spontaneous smile.
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Abstract
PURPOSE Literature on palpebral springs is scarce, and even more so for the Asian population. In this study, the authors evaluated their experience with palpebral spring placement for paralytic lagophthalmos in an Asian population. The authors report the unique challenges encountered due to the distinctive features in Asian eyelids and how they overcome them. To the best of our knowledge, this is the first report on the application of palpebral springs in Asians. METHODS All patients treated for paralytic lagophthalmos in the Department of Surgery, Queen Mary Hospital, from November 2013 to December 2015, were included in this study. The authors retrieved and analyzed the demographic data, preoperative assessment details, and treatment outcomes. RESULTS A total of 17 patients were recruited. The median interval between facial palsy occurrence and surgery was 66 months. Preoperatively, vertical palpebral fissure was 12.3 ± 1.7 mm with margin reflex distance 1 of 3.7 ± 0.3 mm and margin reflex distance 2 of 8.6 ± 1.6 mm. Lagophthalmos before surgery was 9.6 ± 2.3 mm. After the palpebral spring surgeries, vertical palpebral fissure was reduced to 9.1 ± 1.4 mm. margin reflex distance 1 is slightly reduced (3.3 ± 0.8 mm) and margin reflex distance 2 improved to 5.8 ± 1.0 mm. Lagophthalmos reduced significantly to 0.8 ± 1.3 mm. Seven patients required revision procedures. CONCLUSIONS Palpebral spring is a safe and effective treatment for Asian patients with paralytic lagophthalmos. However, surgeons should be aware of the unique challenges associated with the anatomy of Asian eyelids. Special adaptation of the procedure is required to optimize the outcome.
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Hayashi A, Yoshizawa H, Natori Y, Senda D, Tanaka R, Mizuno H. Levator lengthening technique using cartilage or fascia graft for paralytic lagophthalmos in facial paralysis. J Plast Reconstr Aesthet Surg 2016; 69:679-86. [PMID: 26952126 DOI: 10.1016/j.bjps.2016.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/26/2015] [Accepted: 01/09/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Lid loading using gold weights has been commonly used to treat paralytic lagophthalmos (PL); however, the procedure has a relatively high complication rate and the availability of these plates varies among social circumstances. We used a levator lengthening (LL) technique, which originally elongated the levator aponeurosis by inserting a fascia graft between the edge of the levator aponeurosis and the tarsal plate. However, because this procedure tends to result in a wide residual lagophthalmos, we changed the graft material from fascia to conchal cartilage. In this study, we describe in detail our experience with LL using the cartilage graft. METHODS LL was performed in 18 patients with PL. Fascia grafts were used in seven patients and cartilage grafts in 11. Static reconstructions of the lower eyelid and eyebrow were also performed in most patients. Efficacy was evaluated from patient reports of ocular symptoms and by measuring the palpebral fissure width at opening and closing for both eyes. RESULTS All patients experienced improved ophthalmological symptoms, which were more apparent in cartilage cases. The average palpebral fissure at eyelid closure was 1.8 mm in cartilage cases and 4.0 mm in fascia cases. In cases where an eyebrow lift was concurrently performed, the residual lagophthalmos became wider in fascia grafting but remained acceptable in cartilage grafting. DISCUSSION LL is a simple and useful procedure for treating PL with higher efficacy when a cartilage graft is used. However, the level of the upper eyelid can be easily adjusted by changing the fixation position of the cartilage. Additional experience is required to obtain more consistent outcomes.
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Affiliation(s)
- Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Hidekazu Yoshizawa
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuhei Natori
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Daiki Senda
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Rica Tanaka
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hiroshi Mizuno
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
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Hasmat S, Lovell NH, Eviston T, Ekmejian R, Suaning GJ, Clark J. Creating eye closure in patients with facial nerve paralysis using an implantable solenoid actuator. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2015:1357-1360. [PMID: 26736520 DOI: 10.1109/embc.2015.7318620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper proposes the use of an implantable solenoid actuator to create a more natural eyelid closure over current lid loading therapies in patients with facial nerve paralysis (FNP). The actuator works by moving a magnet when a solenoid is activated. This is used to tension a sling applied to the upper eyelid which closes the eye. The sling design has been described elsewhere and creating eye closure using it requires a force of 627 (± 128) mN over a movement of approximately 6 mm. The actuator described here was able to successfully achieve these parameters and repeatedly perform eyelid closure in a cadaveric rabbit model. Device limitations and future improvements have also been identified and discussed.
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Wambier SPF, Garcia DM, Cruz AAV, Messias A. Spontaneous Blinking Kinetics on Paralytic Lagophthalmos After Lid Load with Gold Weight or Autogenous Temporalis Fascia Sling. Curr Eye Res 2015; 41:433-40. [PMID: 26016510 DOI: 10.3109/02713683.2015.1031252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the upper eyelid kinematics during spontaneous blinking in unilateral paralytic lagophthalmos before and after upper eyelid load with gold weight (GW) or autogenous temporalis fascia (TF) sling. DESIGN Comparative case series. SUBJECTS Patients with long-standing unresolved unilateral facial palsy who underwent surgical treatment with GW (n = 8) or upper lid cerclage with TF (n = 10). The contralateral eyelid served as the control for each patient (control group). METHODS Preoperative and postoperative measurements of spontaneous blink kinematics with magnetic search coil and clinical assessment of lid margin position, lagophthalmos and ocular surface exposure, and determine amplitude, maximum velocity and main sequence of spontaneous blinks; relative amplitude of blinks to the pupil center; ocular surface exposure scores; magnitude of lagophthalmos and mid-pupil lid distances. RESULTS The mean (±SE) down-phase amplitude ratio between paralyzed and contralateral eyelids (blink gain) was 10.0% preoperatively for both groups and significantly increased to 29 ± 6% for the GW group (p < 0.05) and 23 ± 4% for the TF group (p < 0.05). At 6 months the gain was significant for the GW group only (32 ± 7%, p < 0.05). There was no effect on the maximum velocity of the blinks or the main sequence of paretic and contralateral blinks with either surgery. Both procedures lowered the lid margin increasing the number of blinks that reached the pupil center. At 6 months this effect was prominent only for the GW group. Exposure keratopathy scores and lagophthalmos decreased postoperatively especially in the GW group. CONCLUSIONS The beneficial effect of lid load surgeries result from a combination of a small increase on the spontaneous blink amplitude and a static effect due to the reduction of the distance between the lid margin and pupil center.
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Affiliation(s)
- Sarah P F Wambier
- a Department of Ophthalmology , Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , Sao Paulo , Brazil and
| | - Denny M Garcia
- a Department of Ophthalmology , Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , Sao Paulo , Brazil and.,b Craniofacial Research Support Center, University of São Paulo , Sao Paulo , Brazil
| | - Antonio A V Cruz
- a Department of Ophthalmology , Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , Sao Paulo , Brazil and.,b Craniofacial Research Support Center, University of São Paulo , Sao Paulo , Brazil
| | - Andre Messias
- a Department of Ophthalmology , Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , Sao Paulo , Brazil and
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Leckenby J, Ghali S, Butler D, Grobbelaar A. Reanimation of the brow and eye in facial paralysis: Review of the literature and personal algorithmic approach. J Plast Reconstr Aesthet Surg 2015; 68:603-14. [DOI: 10.1016/j.bjps.2014.12.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/07/2014] [Accepted: 12/13/2014] [Indexed: 11/19/2022]
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Sendul SY, Cagatay HH, Dirim B, Demir M, Acar Z, Olgun A, Can E, Guven D. Effectiveness of the lower eyelid suspension using fascia lata graft for the treatment of lagophthalmos due to facial paralysis. Biomed Res Int 2015; 2015:759793. [PMID: 25821819 DOI: 10.1155/2015/759793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 02/17/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate of functional and cosmetic effectiveness of lower eyelid sling technique with fascia lata graft in patients with lagophthalmos due to facial paralysis. MATERIAL AND METHOD Ten patients with a mean age of 55.1 ± 19.77 years who underwent lower eyelid sling surgery with a fascia lata graft between September 2011 and January 2014 were included in this prospective study. Preoperatively and postoperatively patients were evaluated in terms of corneal epithelial defects, Schirmer's test, and tear break-up time (TBUT). Cosmetically, vertical eyelid aperture, margin reflex distances 1 and 2 (MRD1 and MRD2) and scleral show were evaluated preoperatively and postoperatively. RESULTS One patient had facial paralysis on the right side whereas the other 9 patients had facial paralysis on the left side. Preoperatively, 3 patients were detected with corneal ulcer, whereas 7 patients were detected with persistent corneal epithelial defects localized in the lower half of the cornea. In the 3 patients with preoperative corneal ulcer, the ulcer recovered with corneal opacity, whereas in the 7 patients with punctate epitheliopathy, postoperative corneal transparency was obtained. DISCUSSION Lower eyelid sling technique with fascia lata graft is an effective technique for the repositioning of the lower eyelid and preventing the corneal complications.
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Abstract
Current options for correction of paralytic lagophthalmos are either temporary (external eyelid weight placement, hyaluronic acid gel or botulinum toxin A injection) or permanent (various procedures for narrowing of the palpebral fissure, upper eyelid weights or spring implantation). Neuroplastic surgery (cross-facial nerve grafting, nerve anastomoses) and muscle transposition surgery is not effective enough. The majority of elderly and medically compromised patients should not be considered for such complicated and long procedures. Upper eyelid weight implantation thus appears the most reliable and simple treatment.
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Affiliation(s)
- N S Iskusnykh
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
| | - Y O Grusha
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, Chair of Eye Diseases, Bolshaya Pirogovskaya St. 2-4, Moscow, Russian Federation, 119991
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Gupta RC, Kushwaha RNS, Budhiraja I, Gupta P, Singh P. Modified silicone sling assisted temporalis muscle transfer in the management of lagophthalmos. Indian J Ophthalmol 2014; 62:176-9. [PMID: 24618488 PMCID: PMC4005234 DOI: 10.4103/0301-4738.128629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: To evaluate the efficacy of modified temporalis muscle transfer (TMT) by silicone sling for the management of paralytic lagophthalmos. Settings and Design: Prospective interventional study. Materials and Methods: Ten patients of lagophthalmos due to facial palsy underwent modified TMT using silicone sling. The patients were followed-up for a period of 3 months. Palpebral aperture in primary gaze and during eye closure were assessed both pre- and postoperatively along with problems associated with lagophthalmos like exposure keratopathy and lacrimation. Statistical Analysis: Paired t-test was applied to measure the statistical outcome. Results: Eight patients achieved full correction of lagophthalmos with no lid gap on closing the eye. The mean (standard deviation (SD)) lid gap on eye closure was 7.7 (0.86) mm preoperatively, 0.5 (0.47) mm at 1st postoperative day, and 0.7 (0.75) mm at 3rd month. There was a reduction in mean lid gap on eye closure of 7 mm at 3 months (P < 0.0001) which is highly significant. The mean (SD) vertical interpalpebral distance during primary gaze was 12.05 (1.12) mm preoperatively, 10 (0.94) mm at 1st postoperative day, and 10.35 (1.08) mm at 3rd month. There was a reduction in mean vertical inter palpebral distance of 1.7 mm at 3 months (P = 0.001) which is significant. Exposure keratitis decreased in five out of six patients at 3 months. Conclusion: Modified TMT by silicone sling is a useful procedure with lesser morbidity and good outcomes for the treatment of paralytic lagophthalmos due to long standing facial palsy.
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Affiliation(s)
- Ramesh C Gupta
- Department of Ophthalmology, Lala Lajpat Rai Hospital, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India
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Goel R, Kamal S, Bodh SA, Kumar S, Kishore J, Malik K, Singh M, Bansal S. Lower eyelid suspension using polypropylene suture for the correction of punctal ectropion. J Craniomaxillofac Surg 2013; 41:e111-6. [DOI: 10.1016/j.jcms.2012.11.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 11/20/2012] [Accepted: 11/20/2012] [Indexed: 11/16/2022] Open
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Kurita M, Takushima A, Shiraishi T, Kinoshita M, Ozaki M, Harii K. Recycle of temporal muscle in combination with free muscle transfer in the treatment of facial paralysis. J Plast Reconstr Aesthet Surg 2013; 66:991-5. [PMID: 23283482 DOI: 10.1016/j.bjps.2012.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 10/20/2012] [Accepted: 12/06/2012] [Indexed: 11/25/2022]
Abstract
We experienced three patients with long-standing unilateral complete facial paralysis who previously underwent temporalis muscle transfer to the cheek for smile reconstruction. All patients complained of insufficient and uncomfortable buccal motion synchronised with masticatory movements and incomplete eyelid closure with ptotic eyebrow. To attain a near-natural smile and reliable eyelid closure, temporalis muscle was displaced from the cheek to the eyelid, and a neurovascular free latissimus dorsi muscle was transferred for the replacement of cheek motion. As a result, cheek motion synchronised with the contralateral cheek upon smiling and sufficient eyelid closure were obtained in all cases. Smile reconstruction using the temporal muscle is an easy and a versatile way in general. However, spontaneous smile is not achieved and peculiar movement of the cheek while eating is conspicuous in some cases. Replacement with neurovascular free latissimus dorsi muscle and recycling previously used temporalis muscle for eyelid closure are considered to be valuable for such cases.
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Affiliation(s)
- Masakazu Kurita
- Department of Plastic Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan.
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