The effects of using spacer grafts on lower-eyelid retraction surgery in patients with facial nerve palsy

Abstract

Purpose To evaluate the effects of the concomitant use of spacer grafts in lateral tarsal strip surgery in patients with facial nerve palsy-related lower-eyelid retraction. Methods Patients who underwent lateral tarsal strip surgery to correct facial nerve palsy-related lower-eyelid retraction were retrospectively reviewed. Postoperative decreases in marginal reflex distance-2 values at 1, 2 and 6 months were measured along with the effects of spacer grafts. Results Forty-five patients (28 males) were included (mean age: 59.56 years). Mean preoperative marginal reflex distance-2 was 6.87 ± 1.34 mm. Twenty patients underwent lateral tarsal strip surgery only (lateral tarsal strip-only); 25 patients underwent lateral tarsal strip surgery using spacer grafts (lateral tarsal strip + graft). Median (interquartile range) follow-up duration was 12.0 (6.0–23.0) months. Retraction was significantly improved and maintained at 1, 2 and 6 months postoperatively in all patients (mean marginal reflex distance-2: 3.78 ± 1.06 mm, 4.30 ± 1.23 mm and 4.72 ± 1.11 mm, respectively). Surgical outcomes were significantly better in the lateral tarsal strip + graft than in the lateral tarsal strip-only group (Δmarginal reflex distance-2: 3.92 vs. 2.05 mm at 1 month, p < 0.001; 3.38 vs. 1.61 mm at 2 months, p = 0.001; 2.88 vs. 1.69 at 6 months, p = 0.042). Subgroup analyses by spacer graft type revealed no significant differences. Conclusion The concomitant use of spacer material in lateral tarsal strip surgery yielded better surgical outcomes than lateral tarsal strip surgery alone. The use of spacer grafts should be considered for correcting severe facial nerve palsy-related lower-eyelid retraction.

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

“…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][68][69][70][71][72][73][74][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][68][69][70][71][72][73][74][75] The sheer weight or size of the tarsus may also play a minor role by further weakening the medial and lateral canthal ligaments.…”

“…10,[67][68][69][70][71][72][73][74][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][68][69][70][71][72][73][74][75] The sheer weight or size of the tarsus may also play a minor role by further weakening the medial and lateral canthal ligaments. 71 In patients with a partial impairment of orbicularis function, a simple lateral canthoplasty may suffice to restore an atonic lower lid into its proper anatomic position.…”

“…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 .…”

“…This superolateral myocutaneous redraping serves another important function. By raising the upper part of the cheek, the palpebromalar and nasojugal sulci are pushed upwards which improves mid-facial symmetry and confers a strategic cosmetic advantage 70,72 . The addition of a hard palate graft may be indicated if there is significant lower eyelid retraction 7,72 .…”

Lower Eyelid Management in Facial Paralysis

“…Placement of a spacer graft into the posterior lamella of the lower eyelid has been described in isolation or in combination with lateral tarsal procedures to augment lower eyelid height in paralytic lagophthalmos. 17,18 Spacer grafts may comprise autologous hard palate or conchal cartilage, or allogenic acellular dermal matrix. 19 Complications of spacer graft placement include insufficient correction and graft buckling or contracture, yielding suboptimal aesthetics and loss of correction over time.…”