Summary
Background
Facial nerve weakness can cause deficient eye closure with reduced corneal protection.
Surgical remedies can be static to oppose the levator muscle (lid loading) or dynamic
procedures, which act to increase the strength of closure. This retrospective cohort
study compares these groups. The hypothesis is that dynamic reconstruction has advantages
over static techniques in terms of eye closure, symptomatic improvement, blink restoration,
and complication rate.
Methods
Two cohorts were compared: those treated with a gold weight insertion into the upper
eyelid and those who had received dynamic reconstruction. These included temporalis
transfer; cross face nerve grafting alone (CFNG) and CFNG followed by free tissue
transfer. Assessments included standard photography and video; measurement of eyelid
excursion including residual gap and if full eye closure was possible. The presence
of the blink reflex and symptoms of dry eye was assessed.
Results
Overall improvement in eye closure was similar with the gold weight compared to dynamic
procedures (5.1 mm vs 5.3 mm). Dynamic procedures however gave improved results in
terms of symptom relief and restoration of blink. They also had fewer complications
and revision rates overall.
Conclusion
The study confirms the hypothesis that dynamic reconstructions of the paralysed eyelid
confer advantages compared to simple lid loading techniques. Improvements in lid excursion
are similar, but symptom improvement and blink restoration are significantly better.
A decision regarding eyelid reanimation should be made early in the patient's journey
of facial reanimation to allow for accurate planning and placement of nerve grafts
at an early stage.
Keywords
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Article info
Publication history
Published online: October 18, 2022
Accepted:
October 4,
2022
Received:
September 21,
2021
Footnotes
Financial disclosure statement – I can confirm that there are no financial disclosures associated with the article.
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Invited commentary on “Are dynamic procedures superior to static in treating the paralytic eyelid in facial paralysis?”Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 77
- PreviewThe approach for eyelid reanimation in patients with facial palsy is frequently underestimated, and reconstructive surgeons tend to focus especially on the smile reanimation1. Although being a retrospective study, the current article2 succeeds in obtaining a considerable sample to compare the static and dynamic procedures, remarking the advantages of the dynamic reanimation and the complications of the gold weights.
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