Facial paralysis is a common sequela of severe craniofacial trauma. The facial nerve is responsible for eyelid closure and controls the blinking mechanism. A patient with facial paralysis will be unable to close the eye on the paralytic side, a condition known as lagophthalmos.
Lagophthalmos is a very alarming sign because it may cause irreversible corneal damage, leading to vision loss and blindness in severe cases.
The brow on the side of the paralysis typically droops and the lower eyelid pulls away from the globe (ectropion). Ectropion can also be caused by cicatrix formation from previous surgeries to repair craniofacial fractures – as in this patient.
Lower eyelid cicatricial ectropion is corrected first. The surgeon releases the fibrous attachments that pull the eyelid down by cutting the cicatrix from soft tissue to bone. A spacer graft may be utilized to prevent further scarring and recurrence of the ectropion. This graft is placed on top of the orbital bone.
A lateral tarsal strip is used to secure the tendon of the lower eyelid to the bone. This procedure restores eyelid tone and improves blinking after surgery. A demonstration of eyelid tightening is shown in the video.
A gold weight implant is used to correct upper eyelid muscle paralysis. This implant is sutured to the tarsal plate of the eyelid on its lower aspect. The gold weight allows full closure of the eye without affecting eyelid opening. The weight of the implant is determined before the operation.
One week after surgery the patient is able to close the eye and the cornea is fully protected. Quality of life is greatly improved, and the patient is very happy.
For more information, contact us.
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