ABSTRACT
Background The dysfunction of the blink reflex the eyelid-closure ability appears in the patients with facial paralysis,and its management is the implantation of mechanical-assisted eye-closure device in the upper eyelid.A novel device is palpebral spring implant.However,there is no similar study in China.Objective This study was to evaluate the clinical efficacy of palpebral spring placement for lagophthalmos caused by facial nerve palsy.Methods This clinical research complied with Helsinki declaration and the protocol was approved by Ethic Committee of Henan Eye Institute & Henan Eye Hospital.Written informed consent was obtained from each patient prior to the surgery.A retrospective serial case-observational study was performed.The medical records of 11 patients who underwent palpebral spring placement for hypophasis due to facial nerve palsy were reviewed at Henan Eye Hospital from August 2010 to November 2012.Palpebral spring placement was performed by the same surgeon to ensure a more even outcomes.Palpebral spring was made by nickel wire,with the diameter of 0.3 mm and implanted on tarsal plate in 11 eyes of 11 patients with symptomatic facial nerve palsy.The lower tip of Levine spring was encased into a small terylene bag and sutured to the anterior tarsal surface during the surgery.Preoperative and postoperative symptoms,upper eyelid margin to mid pupil distance (ULMD),degree of lagophthalmos and eyelid moving scope were examined and compared between before and after operation.The operating complication was followed-up for 8-38 months.Results The discomforted symptoms disappeared in all the operated eyes.The ULMD was (3.51±0.73) mm in preoperation and (3.20±0.86) mm in posteration,without significant difference between them (t=1.36,P=0.10).The degree of lagophthalmos was (5.94±1.57) mm and (1.06±0.98) mm in preoperation and postoperation respectively,showing a significant difference between them (t =9.42,P =0.00).The eyelid moving scope was (5.89±0.70) mm in postoperation,which was significantly increased in comparison with (0.11 ±0.33) mm of preoperation (t =22.97,P =0.00).The palpebral spring implant was regulated in 1 patient during the follow-up duration due to the trauma.No complication in other 10 patients appeared during the follow-up duration,such as implant exposure,metal fatigue or infection.Conclusions Palpebral spring placement is safe and effective for lagophthalmos in patients with facial nerve palsy.
ABSTRACT
Introdução: A paralisia facial é uma síndrome com implicações estéticas e funcionais importantes.A reanimação do segmento facial afetado pode ser realizada por diversas técnicas. Atransposição de músculos regionais inervados por outro nervo craniano não afetado é um dosmétodos utilizados com frequência. O ventre anterior do músculo digástrico, inervado pelonervo miloioideo, ramo do nervo trigêmio, é um retalho bastante usado para a reanimação dadepressão do lábio inferior. Uma maior mobilidade deste retalho poderia permitir a transposiçãodo músculo para outros segmentos da face, ampliando sua utilização na prática clínica.Método: Estudamos o pedículo vásculo-nervoso do ventre anterior do músculo digástricoem 10 cadáveres, a fim de determinar o arco de rotação do seu retalho mantendo intacto oseu nervo aferente, e estudamos os diâmetros da artéria submentoniana, responsável pelo seusuprimento sanguíneo, com o objetivo de determinar a viabilidade de eventual reanastomosemicrocirúrgica. Resultados: Encontramos um arco de rotação médio de 3,71 cm a partirda borda inferior da mandíbula. O diâmetro externo da artéria submentoniana mediu emmédia 1,05 mm, o que permitiria a anastomose microcirúrgica a outro tronco arterial daface, dando uma maior liberdade para a mobilização do retalho. Conclusão: O retalho assimmobilizado tem, portanto, potencial renovado para uso na reanimação da paralisia facial.
Introduction: Fascial palsy is a syndrome with important esthetical and functional implications.The reanimation of the affected segment of the face can be obtained with severaltechniques. The transposition of local muscles, innervated by other cranial nerves, is frequentlyused. The anterior belly of the digastric muscle flap, innervated by the milohyoidnerve, a branch of the trigeminal nerve, is commonly used to treat the denervation of theinferior lip depressor muscle. A greater mobilization of this flap could allow its transpositionto other fascial segments. Methods: We have studied the vascular and nervous pedicle ofthe anterior belly of the digastric muscle in 10 unfixed cadavers, to determine the rotationarch of the flap, keeping its nerve intact. We have also studied the diameters of the submentonianartery, responsible for the blood suply to the flap, in order to evaluate the possibilityof microsurgical anastomosis to other vascular branches. Results: We have found a medianarch of rotation of 3.71 cm from the inferior border of the mandibule. The median externaldiameter of the artery was 1.05 mm, allowing its revascularization with microsurgicaltechnique. Conclusion: This mobilization of the anterior belly of the digastric muscle flapshows a potential for further use in the reanimation of fascial palsy.