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Lailaksiri N, Wanichsetakul P, Saonanon P. Implantation of a Newly Designed Supratarsal Gold Weight versus the Traditional Pretarsal Model for the Correction of Long-standing Paralytic Lagophthalmos: A Retrospective Cohort Study. Arch Plast Surg 2024; 51:163-168. [PMID: 38596156 PMCID: PMC11001443 DOI: 10.1055/s-0043-1777287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/24/2023] [Indexed: 04/11/2024] Open
Abstract
Background The study determined to compare the clinical outcomes of traditional gold weight implantation for the correction of paralytic lagophthalmos with those of a newly designed model. Methods In this retrospective cohort study, we enrolled 30 patients (76% females; average age 60.8 ± 12 years) with facial palsy who underwent implantation of either the traditional pretarsal gold weight (PT group; n = 15) or a new supratarsal model (ST group; n = 15) from May 2014 to April 2019. The main outcome measures were the 12-month postoperative weight prominence, weight migration, improvement of lagophthalmos, upper eyelid contour, and upper eyelid ptosis. The secondary outcome was long-term (24 months) reoperative rate. Results The new model group had significantly better eyelid contour (risk ratio [RR] 3.16, 95% confidence interval [CI] 1.62-6.15, p = 0.001), less weight prominence (RR 1.74, 95% CI 1.13-2.70, p = 0.013), less weight migration (RR 1.31, 95% CI 1.12-1.54, p = 0.001), and less eyelid ptosis (RR 2.36, 95% CI 1.21-4.59, p = 0.011) than the traditional model group. Improvement of lagophthalmos was not statistically significant between the two groups (RR 1.44, 95% CI 0.72-2.91, p = 0.303). The 24-month reoperative rate was 53.3% in the PT group versus 13.3% in the ST group (RR 2.00, 95% CI 1.15-3.49, p = 0.015). Conclusion The newly designed supratarsal gold weight showed superior postoperative outcomes than the standard traditional model.
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Affiliation(s)
- Natthiya Lailaksiri
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pawarit Wanichsetakul
- Department of Ophthalmology, Faculty of Medicine, Thammasat University, Bangkok, Thailand
| | - Preamjit Saonanon
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Sanchez CV, Thachil R, Mitchell DN, Reisch JS, Rozen SM. Lateral Tarsal Strip versus Tensor Fascia Lata Sling for Paralytic Ectropion: Comparison and Long-Term Outcomes. Plast Reconstr Surg 2024; 153:148e-159e. [PMID: 37053441 DOI: 10.1097/prs.0000000000010533] [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: 04/15/2023]
Abstract
BACKGROUND Paralytic ectropion increases risk for corneal injury in facial palsy patients. Although a lateral tarsal strip (LTS) provides corneal coverage through superolateral lower eyelid pull, the unopposed lateral force may result in lateral displacement of the lower eyelid punctum and overall worsening asymmetry. A tensor fascia lata (TFL) lower eyelid sling may overcome some of these limitations. This study quantitatively compares scleral show, punctum deviation, lower marginal reflex distance, and periorbital symmetry between the two techniques. METHODS Retrospective review was performed on facial paralysis patients who underwent LTS or TFL sling surgery with no prior lower lid suspension procedures. Standardized preoperative and postoperative images in primary gaze position were used to measure scleral show and lower punctum deviation using ImageJ, and lower marginal reflex distance using Emotrics. RESULTS Of 449 facial paralysis patients, 79 met inclusion criteria. Fifty-seven underwent LTS surgery and 22 underwent TFL sling surgery. Compared with preoperatively, lower medial scleral show improved significantly with both LTS (10.9 mm 2 ; P < 0.01) and TFL (14.7 mm 2 ; P < 0.01). The LTS group showed significant worsening of horizontal and vertical lower punctum deviation when compared with the TFL group (both P < 0.01). The LTS group was unable to achieve periorbital symmetry between the healthy and paralytic eye across all parameters measured postoperatively ( P < 0.01); and the TFL group achieved symmetry in medial scleral show, lateral scleral show, and lower punctum deviation. CONCLUSION In patients with paralytic ectropion, TFL sling provides similar outcomes to LTS, with the added advantages of symmetry without lateralization or caudalization of the lower medial punctum. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | | | | | - Joan S Reisch
- Population and Data Sciences, University of Texas Southwestern Medical Center
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Aronson S, Applebaum SA, Kelsey LJ, Gosain AK. Evidence-Based Practices in Facial Reanimation Surgery. Plast Reconstr Surg 2023; 152:520e-533e. [PMID: 37647378 DOI: 10.1097/prs.0000000000010539] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the causes and preoperative evaluation of facial paralysis. 2. Discuss techniques to restore corneal sensation and eyelid closure, elevation of the upper lip for smile, and depression of the lower lip for lip symmetry. 3. Outline treatment goals, surgical treatment options, timing of repair, and other patient-specific considerations in appropriate technique selection. SUMMARY Congenital facial paralysis affects 2.7 per 100,000 children; Bell palsy affects 23 per 100,000 people annually; and even more people are affected when considering all other causes. Conditions that impair facial mimetics impact patients' social functioning and emotional well-being. Dynamic and static reconstructive methods may be used individually or in concert to achieve adequate blink restoration, smile strength and spontaneity, and lower lip depression. Timing of injury and repair, patient characteristics such as age, and cause of facial paralysis are all considered in selecting the most appropriate reconstructive approach. This article describes evidence-based management of facial paralysis.
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Affiliation(s)
- Sofia Aronson
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Sarah A Applebaum
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Lauren J Kelsey
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Arun K Gosain
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
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Lu GN, Flynn J. Facial Nerve Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00050-6. [PMID: 37217366 DOI: 10.1016/j.otc.2023.04.004] [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: 05/24/2023]
Abstract
Facial palsy causes profound facial disfigurement in addition to compromise of eye closure, speech articulation, oral competence, and emotive expression. Facial reanimation is paramount to reduce functional sequelae and improve patient quality of life. This article discusses facial nerve reconstruction focusing on the setting of head and neck reconstruction.
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Affiliation(s)
- Guanning Nina Lu
- University of Washington, 325 9th Avenue 4 West, Seattle, WA 98104, USA.
| | - John Flynn
- University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS 66103, USA
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Lowndes Correa Francalacci R, Lessa S, da Costa Aboudib JH. Auricular Cartilage Graft for Lengthening Levator Muscle Aponeurosis With Ectropion Correction for Paralytic Lagophthalmos. Aesthet Surg J 2023; 43:13-23. [PMID: 35788264 DOI: 10.1093/asj/sjac181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Paralytic lagophthalmos can have devastating consequences for vision if left untreated. Several surgical techniques have been described, including the utilization of alloplastic and autologous materials. OBJECTIVES The authors sought to evaluate the effectiveness of the surgical treatment of paralytic lagophthalmos with combined techniques employing autologous material and involving the upper and lower eyelids. METHODS Patients with paralytic lagophthalmos underwent stretching of the levator aponeurosis with interposition of conchal cartilage in the upper eyelid associated with sectioning of the orbitomalar ligament and lateral canthoplasty in the lower eyelid. The effectiveness of the technique was evaluated employing subjective (symptomatology) and objective parameters (ophthalmologic evaluation and measurements of lagophthalmos and marginal reflex distances 1 and 2). RESULTS Eight patients with paralytic lagophthalmos were subjected to the proposed technique. In the postoperative period, 85.7% reported complete improvement of symptoms and 62.5% presented a normal eye examination. The mean lagophthalmos measurement was reduced by 5.93 mm, the mean marginal reflex distance 2 was reduced by 2.61 mm, and the mean marginal reflex distance 1 was reduced by 0.69 mm. CONCLUSIONS The technique presented herein, employing autologous material associated with sectioning of the orbitomalar ligament and lateral canthoplasty, was effective in the treatment of paralytic lagophthalmos and did not present significant complications, such as extrusion. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Sérgio Lessa
- Postgraduate Program in Oculoplastic Surgery, State University of Rio de Janeiro, State University of Rio de Janeiro (UERJ), Rio de Janeiro-RJ, Brazil
| | - José Horácio da Costa Aboudib
- Postgraduate Program in Physiopathology and Surgical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro-RJ, Brazil
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Orbicularis Oculi Muscle Reinnervation Confers Corneal Protective Advantages over Static Interventions Alone in the Subacute Facial Palsy Patient. Plast Reconstr Surg 2020; 145:791-801. [PMID: 32097327 DOI: 10.1097/prs.0000000000006608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Corneal protection is a priority in flaccid facial palsy patients. Denervation of the orbicularis oculi muscle results in weak palpebral closure and predisposes patients to severe corneal sequelae. While periorbital static procedures enhance corneal coverage in repose, voluntary closure is only regained through dynamic reinnervation of the muscle. This study aims to elucidate the added effect of dynamic reinnervation of the orbicularis oculi muscle on long-term corneal integrity as well as on dynamic closure of the palpebral aperture. METHODS Retrospective review was performed on two groups of complete palsy patients: those who received solely periorbital static procedures and those who underwent concomitant orbicularis oculi muscle reinnervation and static lid procedures. Only patients with complete ophthalmic examinations were included. Corneal punctate epithelial erosions in addition to static and dynamic palpebral measurements were serially assessed preoperatively and postoperatively. RESULTS Of 272 facial palsy patients, 26 fit the inclusion criteria. Eleven patients underwent combined muscle reinnervation involving facial-to-masseteric nerve coaptation in addition to static eye procedures, and 15 patients underwent solely static interventions. Analysis revealed a 65.3 percent lower mean punctate epithelial erosion score in reinnervation patients as compared with static patients when evaluated at more than 9 months postoperatively (p < 0.01). Reinnervation patients were also found to have 25.3 percent greater palpebral aperture closure (p < 0.05) and 32.8 percent higher closure velocity (p < 0.01) compared with static patients. CONCLUSION In patients with subacute facial palsy, dynamic reanimation of the orbicularis oculi muscle with concomitant static interventions provides lasting corneal protection not seen in patients who receive solely static interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Abstract
The field of facial paralysis requires the reconstructive surgeon to apply a wide spectrum of reconstructive and aesthetic principles, using a comprehensive array of surgical tools, including microsurgery, peripheral nerve surgery, and aesthetic facial surgery on the road to optimize patient outcomes. The distinct deficits created by different anatomical levels of facial nerve injury require a fundamental understanding of facial nerve anatomy. Palsy duration, followed by location and mechanism, will determine mimetic muscle salvageability, by means of either direct repair, grafting, or nerve transfers, whereas longer palsy durations will necessitate introducing a new neuromuscular unit, whether by muscle transfer or free functional muscle transplant. A thorough history, physical examination, and basic understanding of ancillary studies, emphasizing palsy duration, location, and mechanism of injury, are critical in evaluation, prognostication, and treatment strategies in traumatic facial palsy patients. The importance of ancillary and aesthetic procedures cannot be overstated. Although these do not provide motion, they constitute essential tools in the treatment of facial paralysis, providing both protective and improved aesthetic outcomes, yielding the highest impact in final surgeon and patient satisfaction, bringing our patients to smile not only on the outside, but also on the inside.
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Guthrie AJ, Kadakia P, Rosenberg J. Eyelid Malposition Repair: A Review of the Literature and Current Techniques. Semin Plast Surg 2019; 33:92-102. [PMID: 31037045 DOI: 10.1055/s-0039-1685473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Eyelid malposition is a challenging problem faced by surgeons. Given the delicate nature of the eyelid and its complex anatomy, eyelid repair requires both a comprehensive understanding of eyelid anatomy along with thorough presurgical planning and surgical execution. A wide range of options is available for eyelid reconstruction but the location and extent of the deformity often dictate the type of repair. This article is a review of commonly encountered forms of eyelid malposition. Relevant reconstructive techniques and current evidence-based methods of reconstruction are discussed in detail. Anatomical considerations, the nature of specific defects, pearls of preoperative evaluation, and the reconstructive options available to the facial plastic and oculoplastic surgeon are outlined. Topics discussed include ectropion, entropion, eyelid retraction, and blepharoptosis.
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Affiliation(s)
- Ashley J Guthrie
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pooja Kadakia
- Salus University- Pennsylvania College of Optometry, Elkins Park, Pennsylvania
| | - Joshua Rosenberg
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
PURPOSE OF REVIEW Periocular rehabilitation of the patient with a facial nerve palsy has evolved over time. Although protection of the ocular surface is paramount, application of disfiguring tarsorrhaphies should be utilized only in special situations. The purpose of this review is to discuss current surgical and medical strategies in treatment of the periocular area in patients with facial nerve palsy to give maximal functional and cosmetic results. RECENT FINDINGS Upper lid lagophthalmos is preferentially treated with upper eyelid weights. Platinum has distinct advantages over gold. A supratarsal position of the upper lid weight is preferred over a pretarsal location. Lower lid malposition should be treated as a retraction, rather than an ectropion. Recalcitrant ocular surface disease can be effectively managed with a scleral lens. Tearing in the patient with a facial nerve palsy is often multifactorial; small lumen Jones tubes and botulinum toxin injection to the lacrimal gland should be considered to treat epiphora in these patients. SUMMARY A facial nerve palsy can be devastating for patients from both a functional and cosmetic perspective. Although seismic shifts in treatment of the periocular subunit have not occurred, there are a number of small, yet significant, changes in treatment that should be adopted in taking care of these patients.
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Upper eyelid platinum weight placement for the treatment of paralytic lagophthalmos: A new plane between the inner septum and the levator aponeurosis. Arch Plast Surg 2018; 45:222-228. [PMID: 29788690 PMCID: PMC5968324 DOI: 10.5999/aps.2017.01599] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background The most common surgical treatment for paralytic lagophthalmos is the placement of a weight implant in the upper eyelid; however, this technique confers the risks of implant visibility, implant extrusion, and entropion. In this study, we present a new technique of placing platinum weight implants between the levator aponeurosis and inner septum to decrease such complications. Methods A total of 37 patients with paralytic lagophthalmos were treated between March 2014 and January 2017 with platinum weight placement (mean follow-up, 520.1 days). After dissecting through the orbicularis oculi muscle, the tarsal plate and levator aponeurosis were exposed. The platinum weights (1.0–1.4 g) were fixed to the upper margin of the tarsal plate and placed underneath the orbital septum. Results Five patients could partially close their eye after surgery. The average distance between the upper eyelid and the lower eyelid when the eyes were closed was 1.12 mm. The rest of the patients were able to close their eye completely. Three patients patient developed allergic conjunctivitis after platinum weight insertion, which was managed with medication. None of the patients complained of discomfort in the upper eyelid after surgery. Visibility or extrusion of the implant were observed in three patients. Conclusions Postseptal weight placement is a safe and reproducible method in both primary and secondary upper eyelid surgery for patients with paralytic lagophthalmos. It is a feasible method for preventing implant visibility, implant exposure, and entropion. Moreover, platinum is a better implant material than gold because of its smaller size and greater thinness.
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Malik A, Joshi N. Gold in the balance: How does patient posture affect eyelid closure? Orbit 2017; 36:347-349. [PMID: 28678554 DOI: 10.1080/01676830.2017.1337176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/28/2017] [Indexed: 06/07/2023]
Abstract
A retrospective audit was conducted of four patients with upper eyelid gold weights (inserted >5 years ago) as treatment for facial nerve palsy-related lagophthalmos. Each patient was presently examined for lagophthalmos ("opened" or "closed") at three different patient inclinations (lying flat at 0º, lying back at 45º, and sitting upright at 90º). In all four cases at 0º inclination, the upper eyelid remained "open" with significant lagophthalmos, and therefore the ocular surface was vulnerable. At other inclinations, 45º and 90º, the eyes were substantially "closed" and the ocular surface was protected. We discuss the mechanism by which this occurs. We suggest that patients fitted with upper eyelid gold weight implant who do not show adequate closure during postoperative clinical examination or signs of corneal show should try sleeping in a slightly upright position to aid ocular surface protection.
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Affiliation(s)
- Adeela Malik
- a Moorfields Eye Hospital, NHS Foundation Trust , London , United Kingdom
| | - Naresh Joshi
- b Chelsea and Westminster Hospital, NHS Foundation Trust , London , United Kingdom
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Siah WF, Nagendran S, Tan P, Ali Ahmad SM, Litwin AS, Malhotra R. Late outcomes of gold weights and platinum chains for upper eyelid loading. Br J Ophthalmol 2017; 102:164-168. [PMID: 28689170 DOI: 10.1136/bjophthalmol-2016-310089] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/16/2017] [Accepted: 05/27/2017] [Indexed: 11/04/2022]
Abstract
AIM To identify late outcomes of gold weights (GWs) and platinum chains (PCs) for upper eyelid loading in the management of lagophthalmos. METHODS A retrospective case series of upper eyelid GWs and PCs at a single centre over a 10-year period (2004-2013). Two independent, blinded assessors graded standard photographs for any weight-related morbidity (poor upper eyelid contour, weight prominence and migration). RESULTS Primary upper eyelid loading (high-tarsal technique) was performed in 154 eyelids of 136 patients (facial nerve palsy, n=99; non-paralytic, n=37). A total of 127 eyelids of 110 patients had primary GW insertion. Of these, 40.9% (52/127) had revision surgery: exchange of GW for PC (58%), GW repositioning (25%) and removal of GW (17%). Only 22.2% (6/27 eyelids) with primary PCs required revision surgery. In those not requiring revision surgery, photograph grading showed that both GWs and PCs had weight-related morbidity at late follow-up (median=37.5 months, range 12-110 vs median=33.5 month, range 15-106). GWs had significantly higher rate of weight prominence (p=0.001) and migration (p<0.001) compared with PCs. All PC revisions required one procedure only compared with 10% of GWs revisions requiring two or more procedures. Incidence of gold allergy was 7% (8/110 patients). There was no association between the choice of weight material, physical weight or suture material and eyelid morbidities. CONCLUSION GWs were found to be associated with higher complications and twice more likely to require long-term revision surgery compared with PCs. Despite weight fixation at a high-tarsal location, prominence of PCs can still occur.
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Affiliation(s)
- We Fong Siah
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Sonali Nagendran
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Western Sussex Hospitals NHS Trust, Worthing, West Sussex, UK
| | - Petrina Tan
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | | | - Andre S Litwin
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
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Nerobeev AI, Shurgaya TM, Sayda AS. Paralytic lagophthalmos syndrome in the plastic and maxillofacial surgeon practice. STOMATOLOGII︠A︡ 2016; 95:58-61. [PMID: 27636764 DOI: 10.17116/stomat201695458-61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE to identify and give an objective assessment of all changes in the periorbital region in paralysis orbicularis oculi muscle. METHODS With physical, laboratory and instrumental methods of research, we analyzed the survey of 33 patients with paralytic lagophthalmos. This survey has allowed us to identify the symptoms of periorbital changes characteristic of paralysis orbicularis oculi involved in lagophthalmos development. RESULTS After analyzing the results of a survey of 33 patients with paralytic lagophthalmos, we identified 15 symptoms of changes in the periorbital region. CONCLUSION In our opinion, lagophthalmos should be considered as a syndrome, including certain symptom in a particular case. For adequate closure of the optic fissure and obtaining a good aesthetic result is necessary to simultaneously remove more of the symptoms.
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Affiliation(s)
- A I Nerobeev
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - Ts M Shurgaya
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A S Sayda
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Application of Palpebral Spring in Asian Patients With Paralytic Lagophthalmos. Ophthalmic Plast Reconstr Surg 2016; 33:300-303. [PMID: 27564389 DOI: 10.1097/iop.0000000000000775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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Intracranial Facial Nerve Grafting in the Setting of Skull Base Tumors: Global and Regional Facial Function Analysis and Possible Implications for Facial Reanimation Surgery. Plast Reconstr Surg 2016; 137:267-278. [PMID: 26710031 DOI: 10.1097/prs.0000000000001881] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reconstructive surgeons may encounter patients presenting after intracranial facial nerve resection and grafting in the setting of skull base tumors, who inquire regarding progression, final facial function, and need for future operations. Study goals were to analyze global and regional facial function using established grading systems and videography, while examine variables possibly affecting outcomes. METHODS Between 1997 and 2012, 28 patients underwent intracranial nerve grafting. Fifteen were prospectively evaluated by three facial nerve physical therapists with the Facial Nerve Grading System 2.0 and the Sunnybrook Facial Grading Score for function and the Facial Disability Index for quality of life. Still photographs and videography were used to assess quality of motion and tone, while demographic and medical variables were analyzed regarding their effect on end results. RESULTS Average patient age was 41.9 years (range, 22 to 66 years), and there were 10 women and five men. Average time interval between nerve grafting and evaluations was 42.9 months (range, 12 to 146 months). Both grading scores demonstrated best outcomes in the periorbita and worst outcomes in the brow. Buccinator muscle tone also improved. The average total Facial Disability Index was 67.5 percent. Although not statistically significant, the data suggest that nerve gap length affected total resting symmetry and voluntary movement, whereas preoperative palsy and age may affect total resting symmetry. Perioperative radiation therapy, tumor type, donor nerve, and coaptation technique were not found to affect outcomes. CONCLUSIONS Intracranial facial nerve grafting largely provides better resting tone and facial symmetry, potentially improving end results of future intervention; however, overall voluntary facial motion is poor. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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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] [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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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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Vásquez LM, Medel R. Lagophthalmos after facial palsy: current therapeutic options. Ophthalmic Res 2014; 52:165-9. [PMID: 25342248 DOI: 10.1159/000365519] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 06/25/2014] [Indexed: 11/19/2022]
Abstract
As the facial nerve carries sensory, motor and parasympathetic fibres involved in facial muscle innervation, facial palsy results in functional and cosmetic impairment. It can result from a wide variety of causes like infectious processes, trauma, neoplasms, autoimmune diseases, and most commonly Bell's palsy, but it can also be of iatrogenic origin. The main ophthalmic sequel is lagophthalmos. The increased surface exposure increases the risk of keratitis, corneal ulceration, and potentially loss of vision. Treatment options are wide; some are temporary, some permanent. In addition to gold standard and traditional therapies and procedures, new options are being proposed aiming to improve not only lagophthalmos but also the quality of life of these patients.
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Upper eyelid postseptal weight placement for treatment of paralytic lagophthalmos. Plast Reconstr Surg 2014; 133:70e. [PMID: 24374701 DOI: 10.1097/01.prs.0000436807.42917.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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