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Facial Plast Surg 2023; 39(01): 047-052
DOI: 10.1055/s-0042-1759616
Original Article

Lower Eyelid Management in Facial Paralysis

Nate Jowett 
1   Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Abstract

Correction of lower eyelid retraction is necessary to restore adequate blink in paralytic lagophthalmos. A plethora of static and dynamic surgical techniques have been described for lower eyelid repositioning. This article provides an approach to management of the paralytic lower eyelid, including a summary of existing techniques, case examples, and surgical technique for in-office lower eyelid suspension using a palmaris longus tendon graft.

Keywords

facial paralysis - eyelids - plastic surgery - paralytic lagophthalmos - lower eyelid retraction


Publication History

Article published online:
23 December 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Pereira MV, Glória AL. Lagophthalmos. Semin Ophthalmol 2010; 25 (03) 72-78
    CrossrefPubMedGoogle Scholar
  • 2 Homer N, Fay A. Management of long-standing flaccid facial palsy: periocular considerations. Otolaryngol Clin North Am 2018; 51 (06) 1107-1118
    CrossrefPubMedGoogle Scholar
  • 3 Jowett N. A general approach to facial palsy. Otolaryngol Clin North Am 2018; 51 (06) 1019-1031
    CrossrefPubMedGoogle Scholar
  • 4 Jowett N, Pineda II R. Corneal and facial sensory neurotization in trigeminal anesthesia. Facial Plast Surg Clin North Am 2021; 29 (03) 459-470
    CrossrefPubMedGoogle Scholar
  • 5 Wu P, Chawla A, Spinner RJ. et al. Key changes in denervated muscles and their impact on regeneration and reinnervation. Neural Regen Res 2014; 9 (20) 1796-1809
    CrossrefPubMedGoogle Scholar
  • 6 Conley J. Hypoglossal crossover–122 cases. Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol 1977; 84 (4 Pt 1): ORL-763-ORL-768
    PubMedGoogle Scholar
  • 7 Gavron JP, Clemis JD. Hypoglossal-facial nerve anastomosis: a review of forty cases caused by facial nerve injuries in the posterior fossa. Laryngoscope 1984; 94 (11 Pt 1): 1447-1450
    CrossrefPubMedGoogle Scholar
  • 8 Kunihiro T, Kanzaki J, Yoshihara S, Satoh Y, Satoh A. Hypoglossal-facial nerve anastomosis after acoustic neuroma resection: influence of the time anastomosis on recovery of facial movement. ORL J Otorhinolaryngol Relat Spec 1996; 58 (01) 32-35
    CrossrefPubMedGoogle Scholar
  • 9 Klebuc M. Masseter–to-facial nerve transfer: a new technique for facial reanimation. J Reconstr Microsurg 2006; 22 (03) A101
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Klebuc MJA. Facial reanimation using the masseter-to-facial nerve transfer. Plast Reconstr Surg 2011; 127 (05) 1909-1915
    CrossrefPubMedGoogle Scholar
  • 11 Terzis JK. “Babysitter”: An Exciting New Concept in Facial Reanimation. Paper presented at: Proceedings of the Sixth Int'l Symposium on the Facial Nerve. ; October 2–5, 1988, Rio de Janeiro, Brazil
    PubMedGoogle Scholar
  • 12 Terzis JK, Tzafetta K. The “babysitter” procedure: minihypoglossal to facial nerve transfer and cross-facial nerve grafting. Plast Reconstr Surg 2009; 123 (03) 865-876
    CrossrefPubMedGoogle Scholar
  • 13 Joseph SS, Joseph AW, Douglas RS, Massry GG. Periocular reconstruction in patients with facial paralysis. Otolaryngol Clin North Am 2016; 49 (02) 475-487
    CrossrefPubMedGoogle Scholar
  • 14 Sohrab M, Abugo U, Grant M, Merbs S. Management of the eye in facial paralysis. Facial Plast Surg 2015; 31 (02) 140-144
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Bartholomew RA, Ein L, Jowett N. Lower eyelid sling for primary and revision correction of paralytic lagophthalmos. Facial Plast Surg Aesthet Med 2022; DOI: 10.1089/fpsam.2022.0096.
    CrossrefPubMedGoogle Scholar
  • 16 Vahdani K, Ford R, Garrott H, Thaller VT. Lateral tarsal strip versus Bick's procedure in correction of eyelid malposition. Eye (Lond) 2018; 32 (06) 1117-1122
    CrossrefPubMedGoogle Scholar
  • 17 Kim MJ, Choi YM, Kim N, Choung H-K, Khwarg SI. The effects of using spacer grafts on lower-eyelid retraction surgery in patients with facial nerve palsy. Eur J Ophthalmol 2022; 32 (04) 2072-2077
    CrossrefPubMedGoogle Scholar
  • 18 Krastinova D, Franchi G, Kelly MB, Chabolle F. Rehabilitation of the paralysed or lax lower eyelid using a graft of conchal cartilage. Br J Plast Surg 2002; 55 (01) 12-19
    CrossrefPubMedGoogle Scholar
  • 19 Taban M, Douglas R, Li T, Goldberg RA, Shorr N. Efficacy of “thick” acellular human dermis (AlloDerm) for lower eyelid reconstruction: comparison with hard palate and thin AlloDerm grafts. Arch Facial Plast Surg 2005; 7 (01) 38-44
    CrossrefPubMedGoogle Scholar
  • 20 Park E, Lewis K, Alghoul MS. Comparison of efficacy and complications among various spacer grafts in the treatment of lower eyelid retraction: a systematic review. Aesthet Surg J 2017; 37 (07) 743-754
    CrossrefPubMedGoogle Scholar
  • 21 Gillies H. Experiences with fascia lata grafts in the operative treatment of facial paralysis: section of otology and section of laryngology. Proc R Soc Med 1934; 27 (10) 1372-1382
    PubMedGoogle Scholar
  • 22 de la Torre J, Simpson RL, Tenenhaus M, Bourhill I. Using lower eyelid fascial slings for recalcitrant burn ectropion. Ann Plast Surg 2001; 46 (06) 621-624
    CrossrefPubMedGoogle Scholar
  • 23 Yoo J, Matic D. Transnasal tendon suspension for the paralyzed lower eyelid. J Plast Reconstr Aesthet Surg 2015; 68 (08) 1072-1078
    CrossrefPubMedGoogle Scholar
  • 24 Terzis JK, Kyere SA. Minitendon graft transfer for suspension of the paralyzed lower eyelid: our experience. Plast Reconstr Surg 2008; 121 (04) 1206-1216
    CrossrefPubMedGoogle Scholar
  • 25 Hontanilla B, Gómez-Ruiz R. Surgical correction of lower eyelid paralysis with suture screw anchors. J Plast Reconstr Aesthet Surg 2009; 62 (12) 1598-1601
    CrossrefPubMedGoogle Scholar
  • 26 Senders CW, Tollefson TT, Curtiss S, Wong-Foy A, Prahlad H. Force requirements for artificial muscle to create an eyelid blink with eyelid sling. Arch Facial Plast Surg 2010; 12 (01) 30-36
    CrossrefPubMedGoogle Scholar
  • 27 Sendul SY, Cagatay HH, Dirim B. et al. Effectiveness of the lower eyelid suspension using fascia lata graft for the treatment of lagophthalmos due to facial paralysis. BioMed Res Int 2015; 2015: 759793
    CrossrefPubMedGoogle Scholar
  • 28 Rose EH. Autogenous fascia lata grafts: clinical applications in reanimation of the totally or partially paralyzed face. Plast Reconstr Surg 2005; 116 (01) 20-32 , discussion 33–35
    CrossrefPubMedGoogle Scholar
  • 29 Hayashi A, Maruyama Y, Okada E, Ogino A. Use of a suture anchor for correction of ectropion in facial paralysis. Plast Reconstr Surg 2005; 115 (01) 234-239
    CrossrefPubMedGoogle Scholar
  • 30 Leslie BM, Osterman AL, Wolfe SW. Inadvertent harvest of the median nerve instead of the palmaris longus tendon. J Bone Joint Surg Am 2017; 99 (14) 1173-1182
    CrossrefPubMedGoogle Scholar
  • 31 Lee K, Terzis J. Reanimation of the eye sphincter. Paper presented at: Fifth International Symposium on the Facial Nerve. ; September 3–6, 1984, Bordeaux, France
    PubMedGoogle Scholar
  • 32 Kung TA, Langhals NB, Martin DC, Johnson PJ, Cederna PS, Urbanchek MG. Regenerative peripheral nerve interface viability and signal transduction with an implanted electrode. Plast Reconstr Surg 2014; 133 (06) 1380-1394
    CrossrefPubMedGoogle Scholar
  • 33 Nassif T, Yung Chia C. Neurotized platysma graft: a new technique for functional reanimation of the eye sphincter in longstanding facial paralysis. Plast Reconstr Surg 2019; 144 (06) 1061e-1070e
    CrossrefPubMedGoogle Scholar
  • 34 Ein L, Hadlock TA, Jowett N. Dual-vector gracilis muscle transfer for smile reanimation with lower lip depression. Laryngoscope 2021; 131 (08) 1758-1760
    CrossrefPubMedGoogle Scholar
  • 35 Boahene KO, Owusu J, Ishii L. et al. The multivector gracilis free functional muscle flap for facial reanimation. JAMA Facial Plast Surg 2018; 20 (04) 300-306
    CrossrefPubMedGoogle Scholar