Non-loading surgical techniques for the treatment of paralytic lagophthalmos
What:
Paper Presentation | Présentation d'article
Part of:
When:
3:57 PM, Friday 1 Jun 2018
(6 minutes)
Where:
Metro Toronto Convention Centre (South Building)
- Room 714 A
How:
Authors: Ran Stein, Patrick Boulos
Author Disclosure Block: R. Stein: None. P. Boulos: None.
Abstract Body:
Purpose: Facial nerve paralysis leads to dysfunction of the orbicularis oculi muscle, which interferes with eyelid closure, and cause retraction of both upper and lower eyelids. These lead to exposure keratitis with risk of corneal infection and ulceration. When supportive lubricating treatment fails to maintain an adequate moisture status, the most acceptable surgical methods for the upper eyelid are through lid loading techniques with either gold or platinum implants. However, these carry substantial complication rates, and sometimes also disturbing eyelid appearance. Treatment of upper eyelid retraction with mullerectomy or blepharotomy and raising of the lower eyelid with procedures such as a hard palate graft can reduce lagophthalmos sufficiently to obviate the need for an upper eyelid load. The purpose of this study is to evaluate non-loading techniques for the treatment of paralytic lagophthalmos.
Study Design: Retrospective case series
Methods: Data extraction of all the cases of paralytic lagopthalmos where treatment included either mullerectomy or blepharotomy at Hôpital Maisonneuve-Rosemont performed by a single surgeon (P.B.) between the years 2013-2016. Parameters obtained were patients age, affected side, etiology for nerve paralysis, upper eyelid position and lagophthalmos, and signs of corneal exposure. Also noted were other surgical procedures performed, complications, and the need for consecutive surgeries.
Results: Total of 6 cases of paralytic lagophthalmos, either primary (congenital or acquired, one case each) or secondary (2 cases of schwannoma, 1 following parotidectomy, 1 following trauma) were treated surgically by blepharotomy (1 case) or mullerectomy (5 cases). All patients were noted to exhibit good Bell’s phenomenon. All patients went through surgical procedures addressing the lower eyelid position in order to further reduce lagophthalmos (lateral tarsal strip, palate graft, tarsorrhaphy, medial spindle). Mean lagophthalmos before the surgery measured 7.5 mm (range 4-11 mm). Follow-up ranged between two weeks and fourteen months. Improvement in lagophthalmos was seen in all patients (mean 4 mm, range 0-7.5). One patient required further interventions to both upper and lower eyelid. The upper eyelid position and contour was good in all patients. In the blepharotomy case, an intra-operative ptosis was observed and repaired. No other complications were seen.
Conclusions: The treatment of paralytic lagophthalmos should be tailored to each patient and may include several surgical procedures. Treating the upper eyelid using non-loading surgical techniques should be considered in paralytic lagophthalmos patients, as they provide good esthetic and functional outcomes, without the disadvantages of gold or platinum weights.
Author Disclosure Block: R. Stein: None. P. Boulos: None.
Abstract Body:
Purpose: Facial nerve paralysis leads to dysfunction of the orbicularis oculi muscle, which interferes with eyelid closure, and cause retraction of both upper and lower eyelids. These lead to exposure keratitis with risk of corneal infection and ulceration. When supportive lubricating treatment fails to maintain an adequate moisture status, the most acceptable surgical methods for the upper eyelid are through lid loading techniques with either gold or platinum implants. However, these carry substantial complication rates, and sometimes also disturbing eyelid appearance. Treatment of upper eyelid retraction with mullerectomy or blepharotomy and raising of the lower eyelid with procedures such as a hard palate graft can reduce lagophthalmos sufficiently to obviate the need for an upper eyelid load. The purpose of this study is to evaluate non-loading techniques for the treatment of paralytic lagophthalmos.
Study Design: Retrospective case series
Methods: Data extraction of all the cases of paralytic lagopthalmos where treatment included either mullerectomy or blepharotomy at Hôpital Maisonneuve-Rosemont performed by a single surgeon (P.B.) between the years 2013-2016. Parameters obtained were patients age, affected side, etiology for nerve paralysis, upper eyelid position and lagophthalmos, and signs of corneal exposure. Also noted were other surgical procedures performed, complications, and the need for consecutive surgeries.
Results: Total of 6 cases of paralytic lagophthalmos, either primary (congenital or acquired, one case each) or secondary (2 cases of schwannoma, 1 following parotidectomy, 1 following trauma) were treated surgically by blepharotomy (1 case) or mullerectomy (5 cases). All patients were noted to exhibit good Bell’s phenomenon. All patients went through surgical procedures addressing the lower eyelid position in order to further reduce lagophthalmos (lateral tarsal strip, palate graft, tarsorrhaphy, medial spindle). Mean lagophthalmos before the surgery measured 7.5 mm (range 4-11 mm). Follow-up ranged between two weeks and fourteen months. Improvement in lagophthalmos was seen in all patients (mean 4 mm, range 0-7.5). One patient required further interventions to both upper and lower eyelid. The upper eyelid position and contour was good in all patients. In the blepharotomy case, an intra-operative ptosis was observed and repaired. No other complications were seen.
Conclusions: The treatment of paralytic lagophthalmos should be tailored to each patient and may include several surgical procedures. Treating the upper eyelid using non-loading surgical techniques should be considered in paralytic lagophthalmos patients, as they provide good esthetic and functional outcomes, without the disadvantages of gold or platinum weights.
