Management of the Paralyzed Lower Eyelid by Implanting Auricular Cartilage

Abstract

The success of a procedure to reanimate paralyzed eyelids is determined by the functional and cosmetic results. When the cornea is covered during blinking and sleeping, function has been restored, while a pleasing cosmetic result has been achieved if the eyes appear symmetrical when the lids are open. Several procedures have been developed to restore closure of the paralyzed upper eyelid (implantation of gold weights or open wire springs) or to correct lower lid lagophthalmos and ectropion (lower lid tightening with a Bick procedure or insertion of a closed eyelid spring). In some cases, even a combination of the Bick procedure and insertion of a spring may be insufficient to correct lower lid droop; therefore, we developed a technique to place cartilage into the lower eyelid to correct lid droop. The procedure, suggested by one of us (D.B.S.), has been performed on 51 patients to date. This article reviews our experience with these 51 consecutive patients.

Temporalis Muscle for Facial Reanimation: A 13-Year Experience With 224 Procedures

“…(6) The defect under the scalp left by transposition of the temporalis muscle is filled at the time of surgery with a pre¬ fabricated Silastic implant. (7) Using the technique of Baker and Conley2 of raising periosteum attached to the temporalis muscle fascia, rather than repositioning and sewing the temporalis fascia to the muscles as proposed by Rubin,3 has Placing multiple sutures in the muscle-submucosal layer at the level of the corner of the mouth to overcorrect the smile is essen¬ tial to achieving consistently good results. (11) Using suction drainage postoperatively has significantly reduced the incidence of pooling of serum or blood in the operative area which, in com¬ bination with clindamycin administered perioperatively to de¬ crease the possibility of infection, has led to improved results.…”

Alternative Surgical Treatment of Paralytic Lagophthalmos Using Autogenic Cartilage Grafts and Canthopexy

“…These disadvantages are both often limiting factors for the procedure. 9,10,21 The use of cartilage to correct lagophthalmos was introduced in 1990 by May et al 13 The authors proposed using a section of auricular cartilage to elevate the lower eyelid, a procedure often combined with lateral canthoplasty. In 1996, Iñigo et al 2 proposed lengthening the eyelid with an auricular cartilage graft, placing it between the tarsal plate and the levator aponeurosis.…”

Reanimation following facial palsy: present and future directions

“…28 Hyperlacrimation and synkinesis are also common sequelae of facial nerve palsy. A recent study by Boroojerdi et al 29 found that injection of botulinum toxin into the lacrimal glands was highly effective in treating hyperlacrimation.…”