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, 20 (1), 3-9

Treatment for Ophthalmic Paralysis: Functional and Aesthetic Optimization

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Treatment for Ophthalmic Paralysis: Functional and Aesthetic Optimization

Min Ji Kim et al. Arch Craniofac Surg.

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.

Keywords: Blepharoplasty; Conditioning, eyelid; Ectropion; Esthetics; Facial paralysis; Ptosis, eyelid.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Gold and platinum eyelid weights. Modified from Oh et al. Arch Plast Surg 2018;45:222-8 [2].
Fig. 2.
Fig. 2.
Gold weight placement. Intraoperative incision design and dissection were performed to separate the levator aponeurosis and to expose the tarsal plate. Adapted from Oh et al. Arch Plast Surg 2018;45:222-8 [2].
Fig. 3.
Fig. 3.
Postseptal platinum weight placement. We prefer placement between the levator aponeurosis and inner septum to decrease complications, such as extrusion.
Fig. 4.
Fig. 4.
A 44-year-old male patient had right-sided facial palsy for 13 years secondary to a pleomorphic adenoma resection. At the time of the tumor resection, simultaneous sural nerve and posterior auricular flaps were used. After 10 years, he was still unable to completely close his eye. Therefore, we performed platinum weight insertion (1.2 g) on his right eye, which corrected his lagophthalmos. (A) Preoperative eye open. (B) Preoperative eye closed. (C) Postoperative eye open. (D) Postoperative eye closed.
Fig. 5.
Fig. 5.
A 49-year-old female patient had left-sided facial palsy, related to a hemangioma operation at 3 years of age. After platinum weight insertion, she was able to close her eye naturally, and 3 months later she underwent free functional gracilis muscle transfer for facial reanimation. (A) Preoperative eye open. (B) Preoperative eye closed. (C) Postoperative eye open. (D) Postoperative eye closed.
Fig. 6.
Fig. 6.
A 57-year-old female patient had right-sided facial palsy for 2 years secondary to a parotid cancer resection. A mid-cheek lift with lateral canthopexy was performed. Scleral show was not seen at postoperative 13 months’ follow-up. The patient also underwent platinum weight insertion on her right eye, which corrected her lagophthalmos. (A) Preoperative eye open. (B) Preoperative eye closed. (C) Postoperative eye open. (D) Postoperative eye closed.
Fig. 7.
Fig. 7.
Palmaris longus tendon graft harvest.
Fig. 8.
Fig. 8.
Palmaris longus tendon insertion.
Fig. 9.
Fig. 9.
A 52-year-old male patient had left-sided facial palsy for 6 years. Severe ectropion was observed. After a mid-cheek lift was performed, improvement of scleral show proceeded. (A) Preoperative. (B) Postoperative 15 months.

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