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Park JK, Campbell B, Shipchandler T, Lee HBH. Outcome Comparison of Transconjunctival Müller's Muscle Recession With Levator Disinsertion (TMRLD) to Gold Weight Implantation in the Treatment of Paralytic Lagophthalmos. Ophthalmic Plast Reconstr Surg 2024; 40:326-330. [PMID: 38215464 DOI: 10.1097/iop.0000000000002582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE To compare clinical outcomes of transconjunctival Müller's muscle recession with levator disinsertion (TMRLD) to the traditional gold weight implantation in patients with paralytic lagophthalmos. METHODS A retrospective nonrandomized comparative review of patients who had gold weight implantation and TMRLD surgeries for paralytic lagophthalmos from January 2016 to January 2023 was performed. The main outcome comparisons were measurement changes in lagophthalmos, marginal reflex distance 1, visual acuity, and corneal examination. Complication and reoperation rates were also compared. RESULTS Twenty-six cases of gold weight implantation and 20 cases of TMRLD surgeries were identified. The changes in logMAR visual acuity between gold weight implantation and TMRLD groups were not statistically significant (-0.10 ± 0.48 vs. +0.05 ± 0.14, p > 0.05). The percent improvement in lagophthalmos (62.2% ± 51.8% vs. 58.4% ± 21.1%) and final marginal reflex distance 1 (2.22 ± 1.42 vs. 2.25 ± 1.41 mm) were also comparable between groups ( p > 0.05). Both groups showed similar changes in marginal reflex distance 1 (1.75 ± 1.31 vs. 2.83 ± 1.37 mm) and lagophthalmos (3.77 ± 3.92 vs. 3.36 ± 1.36 mm) ( p > 0.05). The overall complication (15.4% vs. 15.0%) and reoperation rates (15.4% vs. 15.0%) were comparable over the follow-up duration (291.6 ± 437.3 vs. 121.0 ± 177.8 days) ( p > 0.05). CONCLUSION TMRLD is as safe and effective as the gold weight implantation in addressing paralytic lagophthalmos in patients with facial nerve palsy.
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Affiliation(s)
- Ji Kwan Park
- Oculofacial Plastic and Orbital Surgery, Carmel, Indiana, U.S.A
- Ascension St. Vincent Hospital, Indianapolis, Indiana, U.S.A
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | | | - Taha Shipchandler
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Hui Bae Harold Lee
- Oculofacial Plastic and Orbital Surgery, Carmel, Indiana, U.S.A
- Ascension St. Vincent Hospital, Indianapolis, Indiana, U.S.A
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
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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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Guyonvarch P, Benmoussa N, Moya-Plana A, Leymarie N, Mangialardi ML, Honart JF, Kolb F. Thoracodorsal artery perforator free flap with vascularized thoracodorsal nerve for head and neck reconstruction following radical parotidectomy with facial nerve sacrifice: Step-by-step surgical technique video. Head Neck 2021; 43:2255-2258. [PMID: 33818833 DOI: 10.1002/hed.26701] [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: 10/07/2020] [Revised: 01/12/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022] Open
Abstract
Oncological surgery of the parotid region sometimes requires the sacrifice of the facial nerve (parotid cancers, extensive skin cancers of the face, soft tissue sarcomas). The sacrificed portion of nerve can be reconstructed by a vascularized nerve graft, especially if the patient must undergo radiotherapy after surgery. In those cases, the facial nerve sacrifice is associated to an important loss of substance from the parotid region (skin, masseter, parotid, and sometimes jaw). Chimeric flap permit the reconstruction at the same time of the external skin, soft tissues for the volume (fat or muscle), nerve, and bone (ramus and angular part of the mandible). An other option was to raise two flaps but it increased the risk of failure (time of surgery, number of anastomosis, etc.). Reconstruction with a chimeric flap appears to be an ideal choice. Based on these observations, we offer our patients at the Gustave Roussy Institute (Villejuif, France) a thoracodorsal artery perforator (TDAP) free flap including the motor nerve of the latissimus dorsi and vascularized by the thoraco-dorsal pedicle, thus allowing reconstruction in a single surgery. The surgical technique is explained with a step-by-step video. Functional outcomes are also shown in the video. The TDAP or chimeric scapulo-dorsal flap with vascularized nerve has many advantages in the facial reanimation of patients suffering from parotid region cancers. This video article explains surgical steps for other teams.
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Affiliation(s)
- Pierre Guyonvarch
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Nadia Benmoussa
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Nicolas Leymarie
- Department of Plastic Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Maria Lucia Mangialardi
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Jean-François Honart
- Department of Plastic Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Frederic Kolb
- Department of Plastic Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France.,Department of Plastic Surgery, UC San Diego, University of California, San Diego, California, USA
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Eshraghi B, Ghadimi H, Nikdel M. Levator recession and minimal lateral tarsorrhaphy for the management of lagophthalmos and corneal exposure in facial palsy. Eur J Ophthalmol 2019; 31:57-60. [PMID: 31601122 DOI: 10.1177/1120672119881984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Recession of levator muscle can potentially decrease the severity of corneal exposure by reducing margin-reflex distance 1. The purpose of this study is evaluation of effects of levator recession on lagophthalmos in facial palsy. MATERIALS AND METHODS In a non-comparative case series of consecutive patients with exposure keratopathy due to facial paralysis between 2012 and 2017, levator recession was performed through lid crease incision. Small-size (⩽3 mm) lateral tarsorrhaphy was performed on a case-by-case basis for those with moderate-to-severe keratopathy. Preoperative and postoperative measurements of margin-reflex distance 1 and lagophthalmos were compared using paired t-test. RESULTS Thirty-four patients (14 men and 20 women) were enrolled with an average age of 52.3 years. Mean follow-up was 13.3 months (range, 6-36 months). The most common etiology of facial paralysis was Bell's palsy (22 cases), followed by motor vehicle accident (8), parotid surgery (3), and brain tumor surgery (1). No additional procedure was performed for eight patients, while lateral tarsorrhaphy was performed in 26 cases. Mean margin-reflex distance 1 decreased from 5.0 ± 0.4 mm to 4.0 ± 0.5 mm (p < 0.001) and mean lagophthalmos decreased from 3.3 ± 0.9 mm to 1.8 ± 0.9 mm (p < 0.001). Subgroups of patients with additional lateral tarsorrhaphy and without tarsorrhaphy experienced the same amount of reduction in margin-reflex distance 1 and lagophthalmos. CONCLUSION Recession of levator muscle was effective in reduction of margin-reflex distance 1 and lagophthalmos in facial palsy patients. This procedure can be added to the surgical armamentarium for management of patients with facial palsy and lagophthalmos.
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Affiliation(s)
- Bahram Eshraghi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Ghadimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Nikdel
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Labbé D, Guerreschi P. [Facial paralysis sequelae: Long term follow-up revision surgery, redo, continuing care]. ANN CHIR PLAST ESTH 2019; 64:531-539. [PMID: 31492441 DOI: 10.1016/j.anplas.2019.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022]
Abstract
Facial paralysis sequelae have an intense psycho-social impact which imposes an optimal care in the long run. The surgical challenges are numerous, and the therapeutic weapons are multiple. We propose an analysis of these treatments by the prism of their pitfalls and their limits. The complications of the main surgical procedures are described as well as the details of the rework necessary to cope with them or to quickly correct the defects. Moreover, the result limits are detailed with suggestions to improve them. Finally, we develop the necessary iterative treatments or new therapeutic proposals that are essential for the long-term care of these patients whose sequelae of facial paralysis evolve with time and aging. The surgery of facial paralysis is not unequivocal. It requires humility, patience and tenacity to support the patient throughout his life.
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Affiliation(s)
- D Labbé
- Hôpital privé Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France
| | - P Guerreschi
- Service de chirurgie plastique et reconstructrice, CHU de Lille, hôpital Roger Salengro, 59000 Lille, France.
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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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Alban R, Anne Sophie F, Thibault V, Clément D, Sophie B, Pascal R. Septal chondromucosal grafts in paralytic lagophthalmos. J Plast Reconstr Aesthet Surg 2018; 71:1352-1361. [PMID: 30007536 DOI: 10.1016/j.bjps.2018.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 03/30/2018] [Accepted: 04/29/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The risk of sight-threatening complications related to facial paralysis makes palpebral fissure management a priority. Surgery must take account of and adapt to the clinical signs of paralytic lagophthalmos. This therefore presupposes that a sufficient therapeutic arsenal is available. In this report, we propose a technique for palpebral lengthening (lower and/or upper), reconstructing the posterior lamella using a chondromucosal graft harvested from the nasal septum, combined with anterior lamellar repositioning. PATIENTS AND METHOD A 5-year single center retrospective study was conducted, including sixteen patients for a total of nineteen septal chondromucosal grafts. The only inclusion criterion was paralytic lagophthalmos. Functional ophthalmic deficits were recorded (main outcome measure), first preoperatively, then postoperatively. Additionally, the degree of lagophthalmos was measured in order to infer palpebral fissure elongation gain. Surgical consequences and complications were recorded. RESULTS A rapid regression in functional ophthalmic deficits was observed in 87% of patients, improving in stability over time (mean follow-up interval of 34 months). Mean palpebral fissure elongation gain was 3 mm. 53% of patients suffered from complete occlusion of the palpebral fissure. Surgical consequences were uncomplicated. 38% of patients eventually underwent revision surgery. CONCLUSION Palpebral fissure lengthening using septal chondromucosal grafts serves as an alternative to existing treatment methods for paralytic lagophthalmos. Robust functional and cosmetic results, combined with very low morbidity, make this a simple and efficient technique whose indications may be extended.
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Affiliation(s)
- Rouffet Alban
- Service de chirurgie plastique, esthétique et reconstructrice, Centre Hospitalier Universitaire, 4 rue Larrey, 49333 ANGERS, France
| | - Florczak Anne Sophie
- Service de chirurgie plastique, esthétique et reconstructrice, Centre Hospitalier Universitaire, 4 rue Larrey, 49333 ANGERS, France
| | - Vimont Thibault
- Service de chirurgie plastique, esthétique et reconstructrice, Centre Hospitalier Universitaire, 4 rue Larrey, 49333 ANGERS, France
| | - Deranque Clément
- Service de chirurgie plastique, esthétique et reconstructrice, Centre Hospitalier Universitaire, 4 rue Larrey, 49333 ANGERS, France
| | - Boucher Sophie
- Service de chirurgie plastique, esthétique et reconstructrice, Centre Hospitalier Universitaire, 4 rue Larrey, 49333 ANGERS, France
| | - Rousseau Pascal
- Service de chirurgie plastique, esthétique et reconstructrice, Centre Hospitalier Universitaire, 4 rue Larrey, 49333 ANGERS, France.
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Reanimation of the paralyzed lids by cross-face nerve graft and platysma transfer. J Craniomaxillofac Surg 2018; 46:521-526. [DOI: 10.1016/j.jcms.2017.12.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/27/2017] [Accepted: 12/18/2017] [Indexed: 11/23/2022] Open
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Tan P, Wong J, Siah WF, Malhotra R. Outcomes of lower eyelid retractor recession and lateral horn lysis in lower eyelid elevation for facial nerve palsy. Eye (Lond) 2018; 32:338-344. [PMID: 28862257 PMCID: PMC5811694 DOI: 10.1038/eye.2017.174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/02/2017] [Indexed: 01/04/2023] Open
Abstract
PurposeTo report outcomes and complications of lower eyelid retractor recession and lateral horn lysis (RR) for lower eyelid elevation in patients with facial nerve palsy (FNP).Patients and methodsRetrospective review. Patients with FNP undergoing RR alone (group 1) or with adjunctive procedures (canthal suspension-group 2, tarsorrhaphy-group 3, and full-thickness skin graft-group 4) during a 5-year period were included. Patient demographics, lagophthalmos, occurrence of eyelid malpositions, recurrent retraction, and repeat procedures were noted from medical records. Measures of lower eyelid height (LEH) and lid lag on downgaze were obtained from standard photographs.ResultsForty-two patients (23 females, mean age was 59 years) were included. Mean follow-up was 24 months (range 6-77). Median improvement in LEH following surgery was significant in Group 1 (0.90 mm, IQR: 0.37-0.91, P=0.20) and in Group 2 (0.51 mm, IQR: 0.30-1.37, P<0.001), respectively. Median improvement in blink lagophthalmos was 3.00 mm (IQR: 3.00-3.50, P=0.02) in Group 1 and 3.50 mm (IQR: 1.75-5.00, P<0.001) in Group 2. Median improvement in lagophthalmos on gentle eye closure was 2.00 mm (IQR: 1.50-3.00, P=0.02) in Group 1 and 1.00 mm (IQR: 0-2.13, P=0.006) in Group 2. No new cases of ectropion were noted. 23.5% of patients required a repeat RR at a mean interval of 20 (range 1-70) months and a further 9.8% required a third procedure at a mean interval of 21 (range 18-29) months.ConclusionRR improves lower eyelid retraction and lagophthalmos in FNP either alone or when combined as an adjunctive procedure. It does not aggravate paralytic ectropion although repeated retractor recessions may be required to improve retraction.
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Affiliation(s)
- P Tan
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
- Department of Ophthalmology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - J Wong
- Clinical Research Unit, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - W F Siah
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - R Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, 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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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] [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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Occurrence and severity of upper eyelid skin contracture in facial nerve palsy. Eye (Lond) 2016; 30:713-7. [PMID: 26939561 DOI: 10.1038/eye.2016.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/25/2015] [Indexed: 11/08/2022] Open
Abstract
PurposeTo describe the occurrence and severity of upper eyelid skin contracture in facial nerve palsy (FNP).MethodsWe enroled consecutive patients with unilateral FNP into this study. Patients with previous upper eyelid surgery for either side were excluded. We developed a standardised technique to measure the distance between the upper eyelid margin and the lower border of brow (LMBD). FNP was graded using the Sunnybrook grading scale. Its aetiology, duration, and treatment were noted. Upper and lower marginal reflex distance and lagophthalmos were also noted.ResultsSixty-six patients (mean age 51 years) were included. FNP was owing to a variety of aetiologies. LMBD on the paralytic side was shorter than the normal contralateral side in 47 (71%), equal in 15 (23%), and larger in four (6%) patients. The mean contracture was 3.4 mm (median: 3, range: 1-12) with 11 (17%) patients showing 5 mm or more of skin contracture. The mean LMBD on the paralytic side in all patients was significantly smaller than the contralateral side; 30±3.7 (median: 30; 95% CI 29-31) compared with 32±3.7 (median: 32; 95% CI 32-33), respectively, P<0.0001, two-tailed paired t-test.ConclusionTo our knowledge, this is the first study that quantitatively demonstrates contraction of the upper eyelid skin in FNP. This finding is valuable in directing optimal early management to minimise skin contracture and to caution surgeons against unnecessary upper eyelid skin excision.
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Alliez A, Malet T, Bertrand B, Degardin N, Benichou L, Bardot J, Labbé D. [Management of oculo-palpebral consequences in facial paralysis]. ANN CHIR PLAST ESTH 2015; 60:403-19. [PMID: 26321239 DOI: 10.1016/j.anplas.2015.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 11/17/2022]
Abstract
Facial paralysis prognostic depends on eye lesion. In this pathology, lacrymal and palpebral functions will be modified: bad eye closure and leak of tears secretions. It can leads to corneal complications from keratitis to corneal abcedation and visual dysfonction. This chapter details different procedures and their indications to avoid this kind of complications.
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Affiliation(s)
- A Alliez
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de la Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - T Malet
- Centre Monticelli Paradis d'ophtalmologie, 433, rue Paradis, 13008 Marseille, France
| | - B Bertrand
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - N Degardin
- Service de chirurgie plastique pédiatrique, CHU de la Timone enfant, 264, rue Saint-Pierre, 13005 Marseille, France
| | - L Benichou
- Service de chirurgie maxillofaciale, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - J Bardot
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de la Conception, 147, boulevard Baille, 13005 Marseille, France; Service de chirurgie plastique pédiatrique, CHU de la Timone enfant, 264, rue Saint-Pierre, 13005 Marseille, France
| | - D Labbé
- 4, place Fontette, 14000 Caen, France
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[Correction of the position of the cilia in facial paralysis: Technical note]. ANN CHIR PLAST ESTH 2015; 60:221-5. [PMID: 25708730 DOI: 10.1016/j.anplas.2015.01.001] [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: 10/27/2014] [Accepted: 01/19/2015] [Indexed: 11/24/2022]
Abstract
Facial paralysis is a incapacitating pathology that we treat with lengthening temporalis myoplasty for reanimation of the smile. To treat lagophthalmia, we use the extension of the levator of the upper eyelid according Tessier and the asymmetric external blepharorraphy. These techniques can optionally be combined with other techniques, as needed. However, many patients are embarrassed by the appearance of the lashes of the upper eyelid homolateral side facial paralysis. The cilia are lowered and horizontalised, creating a functional disorder by partial "amputation" of the visual field and aesthetic inconvenience. We describe a surgical technique to correct the malposition of the lashes. This technique can be carried out independently or in the lengthening of the temporal myoplasty or another surgical procedure on the eye. In case of extension of the levator of the upper eyelid, the technique we propose requires no additional incision. This is a simple technique and increases very little surgical time. It is fast, little or no morbid, reproducible and provides a significant improvement in the aesthetic and functional patient. This simple technique allows to provide both aesthetic and functional refinement for patients with facial paralysis sequelae.
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Experience and anatomical study of modified lengthening temporalis myoplasty for established facial paralysis. J Plast Reconstr Aesthet Surg 2015; 68:63-70. [DOI: 10.1016/j.bjps.2014.09.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 09/02/2014] [Accepted: 09/15/2014] [Indexed: 11/24/2022]
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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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Cross-face neurotized platysmal muscular graft for upper eyelid reanimation: an anatomic feasibility study. J Craniofac Surg 2014; 25:623-5. [PMID: 24621708 DOI: 10.1097/scs.0000000000000503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Upper eyelid reanimation is one of the most important aspects of facial paralysis. The ideal method would be one that provided dynamic restoration of voluntary eye closure, involuntary blinking, and corneal reflex. Innervation to the platysma has shown to be relatively consistent, which would allow its use as a muscle graft neurotized by the contralateral healthy facial nerve for eyelid reanimation. METHODS Six fresh cadavers, 12 sides, were studied by dissecting the main trunk of the facial nerve and its cervicofacial division. Special attention was paid at the emergence of cervical branches to the platysma and its distribution on the undersurface of the muscle as well as its relationships with regional anatomic references. RESULTS One major branch with 1 or 2 accessory branches was found to emerge from the cervicofacial division, 1.5 cm distal to its origin in the facial nerve trunk. The major branch showed an oblique course, starting approximately 1 cm below the angle of the mandible and coursing toward the inferomedial border of the muscle. Harvest of a 3 × 2 muscle piece with a 10-cm-long neural pedicle was possible in all specimens. When presented over the superior eyelid, the nerve branch was found to reach the contralateral frontal branch of the facial nerve. CONCLUSIONS Innervation to the platysma muscle is relatively constant and consists of 1 major branch accompanied by 1 or 2 accessory branches. Harvest of a muscle flap with a neural pedicle long enough to reach the contralateral healthy side is anatomically feasible.
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