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Hou X, Guo Y, Li S, Lin M, Jia R, Rokohl A, Heindl LM. Lateral tarsal strip procedure for involutional ectropion: A retrospective analysis of 85 cases and a comprehensive literature review. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2021; 1:100004. [PMID: 37846389 PMCID: PMC10577831 DOI: 10.1016/j.aopr.2021.100004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/19/2021] [Accepted: 08/29/2021] [Indexed: 10/18/2023]
Abstract
Purpose To evaluate the postoperative effect of the lateral tarsal strip (LTS) procedure in treating lower eyelid involutional ectropion. Methods A retrospective study was performed on 85 eyelids in 67 patients with involutional ectropion who underwent LTS procedure. Pre- and postoperative lower eyelid laxity and ocular symptoms as well as perioperative complications were evaluated. Snap back test was performed to evaluate the elasticity of lateral canthal tendon loosening and, a lower lid distraction test was performed to evaluate the degree of severity before surgery. Ocular surface diseases were evaluated by the Ocular Surface Disease Index (OSDI), and symptoms including conjunctivitis, corneal ulcer, dry eye syndrome, and ocular pain were recorded. All patients were evaluated within one week and during the follow-up period of 4.2 ± 8.3 months. Furthermore, we reviewed the studies that also investigated the surgical effect of the LTS procedure in the literature from 1979 to 2019. Results The success rate was 95%. Only four eyelids required a second surgical intervention. Seventy-three (86%) eyelids had an excellent position after surgery, 9 (11%) only little improvement, and three had no improvement. No significant difference was found in the postoperative effects between different degrees of ectropion (p > 0.05). No statistical correlation was found between surgical improvements and the ectropion severity (P > 0.05). Fifty-two out of 85 eyes had no discomfort after the surgery. Mild complications included epiphora in 13 eyes (three cases caused by lacrimal punctum eversion), ocular pain in 12 eyes, wound hemorrhage in 12 eyes, and edema in 9 eyelids immediately after surgery, in which 91.2% (n = 21) disappeared within one week and did not need any further treatment. Conclusions The lateral tarsal strip procedure can provide an aesthetically pleasing result for correcting the mild to moderate lower eyelid ectropion while maintaining decent eyelid function.
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Affiliation(s)
- Xiaoyi Hou
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, China
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne: Universitat zu Koln, Germany
| | - Yongwei Guo
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Senmao Li
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne: Universitat zu Koln, Germany
| | - Ming Lin
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Alexander Rokohl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne: Universitat zu Koln, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Ludwig M. Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne: Universitat zu Koln, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
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Facial nerve paralysis: A review on the evolution of implantable prosthesis in restoring dynamic eye closure. J Plast Reconstr Aesthet Surg 2021; 75:248-257. [PMID: 34635457 DOI: 10.1016/j.bjps.2021.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/10/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
Facial nerve paralysis (FNP) is a debilitating condition that leaves those affected with disfigurement and loss of function. The most important function of the facial nerve is protecting the eye through eye closure and blinking. A series of reanimation techniques have been reported to restore dynamic function in FNP, but the lack of a universally accepted method that is reliable and reproducible with immediate effect has led to the introduction of several implantable devices. Most of these devices have been applied to assist blinking; however, the delicate anatomy and unique mechanics of eye closure are difficult to replicate. Lid loading is the most frequently used implant today, which is a passive device that can aid in volitional eye closure but has a limited effect on blinking. Dynamic action can be achieved with active prostheses but achieving successful long-term function remains elusive. Device action must also be coupled with a real-time feedback mechanism in order to capture the natural variation in facial muscle movements. This review discusses all prostheses used for restoring eye closure and blinking to date and explores their relative merits.
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Hasmat S, McPherson S, Suaning GJ, Lovell NH, Hubert Low TH, Clark JR. Recreation of eyelid mechanics using the sling concept ✰. J Plast Reconstr Aesthet Surg 2020; 73:942-950. [PMID: 32081580 DOI: 10.1016/j.bjps.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/01/2019] [Accepted: 12/30/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paralytic lagophthalmos causes major functional, aesthetic and psychological problems in patients with facial paralysis. The Bionic Lid Implant for Natural Closure (BLINC) project aims to restore eyelid function using an implanted electromagnetic actuator combined with an eyelid sling. The authors performed a preliminary study using cadaveric heads to investigate the optimal application of an eyelid sling in various configurations around the orbit. METHODS The sling was tested in a cadaveric sheep head using 2 medial anchor points and 4 lateral ostectomy points. An impulse was generated using gravitational force to test each combination of medial and lateral sling insertion sites using weights between 10 and 50 g. Each generated blink was recorded and analysed. The final result was validated in a human cadaveric model. RESULTS The maximum amount of eye closure and closure speed displayed in sheep were 83.7 ± 9.4% of total closure and 70.6 ± 6.9 mm/s at a maximum force of 490 mN, respectively. The 2 inferior lateral attachments performed better at displacing the eyelid than the superior attachments. The position with the highest degree of eye-closure (improvement of 21.6%, p < 0.001) and speed (improvement of 30.4 mm/s, p < 0.001) was the combination of a posterior medial attachment and an inferior-posterior lateral attachment, which resulted in a near physiological closure in human cadaver. CONCLUSION Closure improved with an inferior lateral position due to increased force acting in the direction of closure. Posterior positioning increases force acting radially, towards the centre of eyelid movement. The latter directs the closure force to effectively move the eyelid around the curved globe.
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Affiliation(s)
- Shaheen Hasmat
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales 2006, Australia; Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia; Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia.
| | - Shaun McPherson
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Gregg J Suaning
- School of Aerospace Mechanical & Mechatronic Engineering, University of Sydney, Camperdown, New South Wales 2006, Australia
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, UNSW Sydney, New South Wales 2052, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia; Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia; Central Clinical School, University of Sydney; Sydney, Camperdown, New South Wales 2050, Australia
| | - Jonathan R Clark
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales 2006, Australia; Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia; Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia; Central Clinical School, University of Sydney; Sydney, Camperdown, New South Wales 2050, Australia
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Dedhia R, Hsieh TY, Chin O, Shipchandler TZ, Tollefson TT. Outcomes From Lateral Eyelid Coupling for Facial Paralysis Using the Modified Tarsoconjunctival Flap. JAMA FACIAL PLAST SU 2019; 20:381-386. [PMID: 29621372 DOI: 10.1001/jamafacial.2018.0070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance In the setting of facial paralysis, inadequate eyelid closure and lower eyelid ectropion can lead to corneal exposure and impaired quality of life. Repair of paralytic ectropion is challenging, and an ideal surgical approach for all cases has not been identified. Objective To assess the patient-reported outcomes and eyelid position improvement in patients with flaccid facial paralysis undergoing lateral eyelid coupling with a tarsal strip canthoplasty and modified tarsoconjunctival flap to correct eyelid malposition. Design, Setting, and Participants Review of medical records of adults with flaccid facial paralysis who underwent a single-stage tarsal strip canthoplasty and modified tarsoconjunctival flap at a tertiary academic center. Inclusion criteria included a minimum of 3 months of follow-up. Intervention The lateral upper and lower eyelid are coupled with the hybrid tarsoconjunctival flap. Main Outcomes and Measures Patient-reported outcome measures and objective photograph analysis. Preoperative and postoperative Facial Clinimetric Evaluation (FaCE) scores and Moe Ectropion Grading Scale scores were compared. The relationship between radiation therapy (RT) and outcomes was analyzed. Results Sixteen patients (8 [50%] female; mean [SD] age at surgery, 71.5 [9.6] years) were identified between January 2014 and August 2017. Twelve (75%) had paralysis from facial nerve sacrifice during cancer ablation. The mean time between paralysis and referral for surgical repair of ectropion was 23 months (range, 0-151 months) and mean follow-up after surgery was 9.8 months (range, 3-39 months). The most common symptom was epiphora, which was significantly reduced after surgery (75% vs 25%; P = .01). Median Moe Ectropion Grading Scale score improved from 3 (interquartile range, 2-3) to 0 (interquartile range, 0-1; P < .001). Quality of life measured using the FaCE scale demonstrated a significant improvement in mean eye comfort (from 18.8 [95% CI, 2.3-35.2] to 47.9 [95% CI, 31.9-63.9]; P = .01) and lacrimal control scores (from 12.5 [95% CI, 0-29.2] to 45.8 [95% CI, 29.3-62.3]; P = .03) in the 6 patients in the RT group, but no difference in the 4 patients in the non-RT group. Conclusions and Relevance Ocular symptoms, eyelid appearance, and quality of life were improved after lateral eyelid coupling among patients with flaccid facial paralysis and paralytic ectropion. The tarsoconjunctival flap does limit peripheral vision, but is reversible if dynamic eyelid closure is returned with nerve grafting. Level of Evidence 4.
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Affiliation(s)
- Raj Dedhia
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
| | - Tsung-Yen Hsieh
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
| | - Oliver Chin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
| | - Taha Z Shipchandler
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - Travis T Tollefson
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
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Pinelli M, Starnoni M, De Santis G. A Simplified and Practical Surgical Treatment for Medial Ectropion: A Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2102. [PMID: 31333921 PMCID: PMC6571293 DOI: 10.1097/gox.0000000000002102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/19/2018] [Indexed: 11/25/2022]
Abstract
We present the case of a 81-year-old patient with right facial palsy suffering from recurrent medial ectropion with lower lateral dislocation of the lacrimal punctum causing epiphora and photophobia. The patient was first treated for ectropion with lateral tarsal strip procedure. Unfortunately, this surgical procedure did not get the expected result. This was the reason we used the Mitek anchor system to fix the lower lateral dislocation of the punctum. We had no recurrence of symptoms during a follow-up period of 18 months.
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Affiliation(s)
- Massimo Pinelli
- Division of Plastic Surgery, University of Modena and Reggio Emilia, Largo Pozzo 71, 41124 Modena, Italy
| | - Marta Starnoni
- Division of Plastic Surgery, University of Modena and Reggio Emilia, Largo Pozzo 71, 41124 Modena, Italy
| | - Giorgio De Santis
- Division of Plastic Surgery, University of Modena and Reggio Emilia, Largo Pozzo 71, 41124 Modena, Italy
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Kim MJ, Oh TS. Treatment for ophthalmic paralysis: functional and aesthetic optimization. Arch Craniofac Surg 2019; 20:3-9. [PMID: 30840813 PMCID: PMC6411530 DOI: 10.7181/acfs.2019.00066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/18/2019] [Indexed: 12/03/2022] Open
Abstract
Facial nerve palsy has an effect on a person's well-being functionally and psychologically. Therefore, comprehensive patient management is essential. One of the most common uncomfortable and potentially debilitating features is associated with the incapacity for eye closure. Restoration of eye closure is a key consideration during the surgical management of facial palsy. In this article, we introduce simple surgical methods-which are relatively easy to learn and involve the upper and lower eyelids-for achieving eye closure. Correcting upper eyelid function involves facilitating the component of eye closure that is in the same direction as gravity and is, therefore, less complicated and favorable outcomes than correction of lower lid. Aesthetic aspects should be considered to correct the asymmetry caused by facial palsy. Lower eyelid function involves a force that opposes gravity for eye closure, which makes correction of lower eyelid ectropion more challenging than surgery for the upper eyelid, particularly in terms of effecting a sustained correction. Initially, proper ophthalmic evaluation is required, including identifying the chronicity and severity of ectropion. Also, it is important to determine whether or not lateral canthoplasty is necessary. The lateral tarsal strip procedure is commonly used for lower lid correction. However, effective lower lid correction can be achieved with better cosmesis when extensive supporting techniques are applied, including those involving cheek tissue.
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Affiliation(s)
- Min Ji Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Suk Oh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Application of Kuhnt-Szymanowski Procedure to Lower Eyelid Margin Defect after Tumor Resection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1230. [PMID: 28280671 PMCID: PMC5340486 DOI: 10.1097/gox.0000000000001230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Abstract
Background: Lower eyelid reconstruction after tumor removal is always challenging, and full-thickness defects beyond half of the eyelid length require a flap from a part other than the remaining lower eyelid, such as the temporal area or the cheek. Objective: We aimed to report our experience of applying Smith-modified Kuhnt–Szymanowski, one of the most popular procedures for paralytic ectropion, for reconstructing oblong full-thickness lower eyelid margin defect. Materials and Methods: We performed Smith-modified Kuhnt–Szymanowski on 5 cases of oblong full-thickness lower eyelid margin defect after skin cancer removal. The mean age of patients was 80.0 years. The horizontal widths of the defects ranged from half to two-thirds of the lower eyelid length and the vertical width ranged from 5 to 9 mm. Results: We obtained good functional and esthetic results in all cases. No patients developed ectropion or lower eyelid distortion, and all patients were satisfied with their results. Conclusions: We utilized the procedure for morphological revision as a reconstructive procedure for eyelid margin defect by considering the defect as a morphological deformity of the eyelid margin; thus, donor tissue was not required to fill the defect and we could accomplish the reconstruction simply, firmly, and less invasively.
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Long-Term Outcome of Combined Lateral Tarsal Strip With Temporal Permanent Tarsorrhaphy for Correction of Paralytic Ectropion Caused By Facial Nerve Palsy. J Craniofac Surg 2015; 26:e409-12. [DOI: 10.1097/scs.0000000000001875] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Yu Y, Sun J, Chen L, Liu L. Lid loading for treatment of paralytic lagophthalmos. Aesthetic Plast Surg 2011; 35:1165-71. [PMID: 21556983 DOI: 10.1007/s00266-011-9740-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 04/07/2011] [Indexed: 02/07/2023]
Abstract
Lagophthalmos secondary to facial palsy is a most clinically important condition that requires effective and early treatment because prolonged corneal exposure may cause corneal lesions, ranging from corneal spots to corneal ulceration and finally blindness. Lid loading is the therapy used most commonly to treat the condition. This method was first described in 1950, modified in 1966, and popularized in 1974. Since its inception, only several reviews have referred to the technology, but they talked about only parts of this technology and did not provide information on the technology overall. This review discusses lid loading in detail. This method now often uses gold and platinum as the material for the implant and should be done as early as possible in those patients whose paralytic lagophthalmos has little chance of being reversed. This method has shown good clinical results and given patients a better perspective. Of course, this method has its intrinsic complications such as allergic reactions, extrusion, and migration. However, with modification of the implant and the surgical procedure, the complication rate has decreased. In conclusion, although lid loading cannot solve all the problems associated with the paralyzed eyelid, it is a simple, reversible, and effective way to treat paralytic lagophthalmos.
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Affiliation(s)
- Yongchun Yu
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People's Republic of China
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Terzis JK, Kyere SA. Minitendon Graft Transfer for Suspension of the Paralyzed Lower Eyelid: Our Experience. Plast Reconstr Surg 2008; 121:1206-1216. [DOI: 10.1097/01.prs.0000305520.07311.fb] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Customized gold weight eyelid implantation in paralytic lagophthalmos. The Journal of Laryngology & Otology 2008; 122:1088-91. [PMID: 18312710 DOI: 10.1017/s0022215108001886] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Gold eyelid implantation is widely considered the procedure of choice to reanimate the upper eyelid in paralytic lagophthalmos. Commercially supplied implants are not readily available in all places and are sometimes cumbersome to import. OBJECTIVE We aimed to devise a method whereby every surgeon performing gold eyelid implantation could have easy and quick access to the implant. Furthermore, we aimed to develop a means of creating an implant of the exact weight required for complete eyelid closure. STUDY DESIGN AND SETTING A prospective study was performed from 1997 to 2005 in a tertiary research hospital, involving 50 subjects requiring gold upper eyelid implantation and using the technique in question. RESULTS Only patients with a minimum follow up of one year were included in the study group. Symptoms improved in 96 per cent of subjects, who were able to dispense with eyedrops and eye ointments. Visual acuity improved in 92 per cent of patients. There were two extrusions amongst the early cases. CONCLUSION AND SIGNIFICANCE Customized gold eyelid implantation offers an alternative in regions where commercial implants are not easily obtained.
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Abstract
Facial nerve palsy affects individuals of all ages, races, and sexes. Psychological and functional implications of the paralysis present a devastating management problem to those afflicted, as well as the carriers. Since Sir Charles Bell's original description of facial palsy in 1821, our understanding and treatment options have expanded. It is essential that a multidisciplinary approach, encompassing ophthalmologists; Ear, Nose, and Throat surgeons; plastic surgeons; and psychologists work closely to optimize patient management in a staged approach. Although the etiology remains unknown, strong histological, cerebral spinal fluid, and radiological evidence suggests a possible association with herpes simplex virus in idiopathic facial nerve palsy (Bell's palsy). The use of steroids has been suggested as a means of limiting facial nerve damage in the acute phase. Unfortunately, no single randomized control trial has achieved an unquestionable benefit with the use of oral steroid therapy and thus remains controversial. In the acute phase, ophthalmologists play a pivotal role in preventing irreversible blindness from corneal exposure. This may be successfully achieved by using intensive lubrication, medical therapy (botulinum toxin), or surgery (upper lid weighting or tarsorraphy). Once the cornea is adequately protected and recovery deemed unlikely, longer term planning for eyelid and facial reanimation may take place in an individualized manner. Onset is sudden and management potentially lengthy. Physician empathy, knowledge, and experience are essential in averting long-term lifestyle and psychological discomfort for patients.
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Affiliation(s)
- Imran Rahman
- Manchester Royal Eye Hospital, Manchester, United Kingdom
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Chang L, Olver J. A Useful Augmented Lateral Tarsal Strip Tarsorrhaphy for Paralytic Ectropion. Ophthalmology 2006; 113:84-91. [PMID: 16343628 DOI: 10.1016/j.ophtha.2005.06.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Accepted: 06/01/2005] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Patients with paralytic ectropion and lagophthalmos may experience keratitis and may pose a functional and aesthetic surgical challenge. Various methods are used to reduce the vertical palpebral aperture, including lateral tarsal strip (LTS) or a lateral tarsorrhaphy. We modified the LTS to differentially shorten and elevate the lower lid more than the upper: an augmented LTS tarsorrhaphy (aug-LTS-T). This study aimed to evaluate the technique. DESIGN Prospective noncomparative surgical trial in which preoperative and postoperative symptoms, margin reflex distances, vertical palpebral aperture (PA), lagophthalmos, and corneal findings were recorded. The data were analyzed at 6 months after surgery using the Wilcoxon sign-rank test for nonparametric data. PARTICIPANTS Fourteen consecutive adult patients (15 eyelids) with chronic lagophthalmos and paralytic ectropion. METHODS Patients underwent aug-LTS-T. This consisted of a long strip (10-15 mm) that is attached to the outer temporal orbital rim, at a point higher than a conventional LTS. It included removal of a small part of the upper eyelid anterior lamella laterally to pass the long strip up high enough. MAIN OUTCOME MEASURES Improvement of symptoms, reduction of lower margin reflex distance, lagophthalmos, and improvement of corneal signs. RESULTS Minimum follow-up was 6 months. There was a significant reduction in PA (P = 0.005) and lagophthalmos (P = 0.0002) with improvement of corneal signs (14 of 15 eyelids = 93%). Surgery was successful anatomically in 14 of 15 eyelids (93%) with low morbidity. CONCLUSIONS We describe the augmented LTS tarsorrhaphy and find it effective in the treatment of severe lower eyelid ectropion resulting from facial palsy.
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Affiliation(s)
- Lydia Chang
- Oculoplastic and Orbital Service, Western Eye Hospital, St. Mary's National Health Service Trust, London, United Kingdom
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Abstract
The ophthalmologist plays a pivotal role in the evaluation and rehabilitation of patients with facial nerve palsy. It is crucial to recognize and treat the potentially life-threatening underlying causes. The immediate ophthalmic priority is to ensure adequate corneal protection. The medium to long-term management consists of treatment of epiphora, hyperkinetic disorders secondary to aberrant regeneration and poor cosmesis. Patients should be appropriately referred for general facial re-animation. This review aims to provide a guide to the management of this complex condition.
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Affiliation(s)
- V Lee
- Central Eye Service, Central Middlesex Hospital, Acton Lane, Park Royal, Acton London, UK.
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Snyder MC, Johnson PJ, Moore GF, Ogren FP. Early versus late gold weight implantation for rehabilitation of the paralyzed eyelid. Laryngoscope 2001; 111:2109-13. [PMID: 11802006 DOI: 10.1097/00005537-200112000-00005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study is to evaluate the outcomes and complications associated with early gold weight implantation for management of the paralyzed eyelid. STUDY DESIGN A retrospective review of clinical charts was conducted to analyze results and complications in patients who underwent gold weight implantation within 30 days of onset of facial nerve paralysis and to compare these outcomes with those of patients who received gold weights after a traditional waiting period. METHODS The charts of 67 patients who underwent gold weight implantation during the time period of this study were reviewed. Patients were categorized into "early" or "late" groups based on whether gold weights were implanted before or after 30 days following onset of facial nerve paralysis. Etiology of facial nerve paralysis, degree of paralysis, timing of surgery, and outcomes of the procedure, including degree of lid closure and complication rates, were compared between the two groups. RESULTS Of the 67 patients, 49.3% underwent gold weight implantation within 30 days of onset of paralysis and 50.7% received gold weights after 30 days. A total of 89.2% of all patients who underwent implantation in this study achieved satisfactory lid closure after the initial procedure. Both early and late implantation groups had statistically similar lid closure and complication rates. CONCLUSIONS Implantation of gold weights within 30 days of paralysis is as effective for the management of paralytic lagophthalmos as delayed implantation and is not associated with higher complication rates. Early implantation of gold weights should be considered in all patients with paralytic lagophthalmos.
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Affiliation(s)
- M C Snyder
- Department of Otolaryngology--Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198-1225, USA.
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