Outcomes of lower eyelid retractor recession and lateral horn lysis in lower eyelid elevation for facial nerve palsy

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.

Facial Nerve Palsy and the Eye: Etiology, Diagnosis, and Management

“…Reconstruction of the lower eyelid is the second crucial step in reanimation of the periocular region in patients with persistent FNP 10,67 . There are different factors at play that ultimately decide the position of the lower eyelid, so that the management plan should be individualized and multiple repeated procedures may be required if this multifactorial etiology is to be fully addressed 10,67–75 . The factors at play include the degree of gravitational or paralytic ectropion of the lower lid, the status of the medial and lateral canthal ligaments, and the extent or degree of midface descent 67–75 .…”

Direct Brow Lift and Skin Contraction in Facial Nerve Palsy: A Switch Technique

“…9 All 4 patients underwent additional procedures at the time of surgery, including retractor recession with horn lysis to elevate the eyelid (Patients 1-4), medial canthal tendon plication to address medial canthal tendon laxity (Patients 1 and 4), and insertion of upper eyelid platinum segment weight to address lagophthalmos (Patient 4). [10][11][12] Patients were followed up for an average 11 months (range = 6-18 months). One postoperative complication was noted, a partial graft necrosis that healed by the final postoperative visit.…”

“…9 All 4 patients underwent additional procedures at the time of surgery, including retractor recession with horn lysis to elevate the eyelid (Patients 1–4), medial canthal tendon plication to address medial canthal tendon laxity (Patients 1 and 4), and insertion of upper eyelid platinum segment weight to address lagophthalmos (Patient 4). 10–12…”

Surgical Treatment of the Atonic Lower Eyelid Ectropion

“…При атоническом вывороте нижнего века для устранения его провисания широко применяют различные виды операций сшивания век, укорочения, подтягивания его атрофически измененных, растянутых тканей [38,26,27,35]. При этом «золотым» стандартом хирургического лечения больных с атонией нижнего века и угрозой кератопатии является тарзорафия, с эффектом которой принято сравнивать результаты других операций подобного типа [33,52]. Тем не менее, по мнению многих авторов, тарзорафия имеет ряд недостатков.…”

“…Помимо различных видов тарзорафии в пластической офтальмохирургии представлены шовные подтягивания наружного угла нижнего века [28], кантопластики, тарзопексии, клиновидные иссечения тканей века, используются всевозможные модификации фиксирующих швов [2,29,35,48]. Однако при самостоятельном применении выше указанных способов лечения добиться стойкого клинико-анатомического эффекта удается не всегда, что требует их оптимизации [1,2,7,10,52]. Так, по мнению S.F.…”