Surgical approach to model facial nerve paralysis in an ovine model for in vivo testing of a novel intervention

J D Cleary; O Kékesi; I Wise; T H Low; N H Lovell; R Gupta; J De Almeida Silva; J R Clark; G J Suaning

doi:10.1016/j.bjps.2025.03.045

Surgical approach to model facial nerve paralysis in an ovine model for in vivo testing of a novel intervention

J Plast Reconstr Aesthet Surg. 2025 Jun:105:23-33. doi: 10.1016/j.bjps.2025.03.045. Epub 2025 Mar 22.

Authors

J D Cleary¹, O Kékesi², I Wise³, T H Low⁴, N H Lovell⁵, R Gupta⁶, J De Almeida Silva⁷, J R Clark⁸, G J Suaning⁹

Affiliations

¹ School of Biomedical Engineering, University of Sydney, Sydney, Australia. Electronic address: jacinta.cleary@sydney.edu.au.
² School of Biomedical Engineering, University of Sydney, Sydney, Australia.
³ Laboratory Animal Services, University of Sydney, Sydney, Australia.
⁴ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Sydney, Australia; Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
⁵ Graduate School of Biomedical Engineering, and Tyree Institute of Health Engineering, UNSW, Sydney, Australia.
⁶ Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁷ Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia.
⁸ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia.
⁹ School of Biomedical Engineering, University of Sydney, Sydney, Australia; FRIAS/FRESCO Fellow, University of Freiburg, Freiburg, Germany.

PMID: 40188556
DOI: 10.1016/j.bjps.2025.03.045

Abstract

Facial nerve paralysis (FNP) disrupts neural inputs to the facial muscles, the most significant being those responsible for blinking. This loss often results in discomfort, corneal exposure, and if improperly treated, vision loss. FNP typically presents unilaterally, resulting in an asymmetric face, causing distress and social isolation. The Bionic Lid Implant for Natural Closure (BLINC) was developed to restore functional blinking in patients with FNP by mechanically actuating eyelid movement via an upper eyelid sling, with a focus on restoring a natural and symmetric appearance. To move this novel intervention toward clinical application, a reliable animal model was needed to assess the function and safety of such a device and optimize the surgical implantation of BLINC. The sheep was chosen owing to the anatomical size and shape similarities of the orbit relative to humans, lending to the testing of human-sized implants. Four sheep underwent facial nerve resection and subsequent BLINC implantation in the temporal fossa. Postoperative assessments confirmed uneventful surgical recovery and effective paralysis induction with no additional functional deficits, supporting the use of this ovine model of FNP for the assessment of novel interventions. The study demonstrates the feasibility of surgical implantation of the BLINC device in a large animal model, laying the groundwork for further testing and eventual human application.

Keywords: Active implantable medical device (AIMD); Bionic lid implant for natural closure (BLINC); Facial nerve paralysis; Ovine model.

MeSH terms

Animals
Blinking / physiology
Disease Models, Animal
Eyelids* / surgery
Facial Nerve* / surgery
Facial Paralysis* / physiopathology
Facial Paralysis* / surgery
Sheep