Surgical treatment of lagophthalmos in long-standing facial palsy: Ear cartilage graft for elongating the levator palpebrae muscle

ABSTRACT

Lagophthalmos is a major problem facing any patient with long-standing facial palsy. Unopposed action of the levator palpebrae following orbicularis oculi paralysis gives an unnatural, wide-eyed look compared to the normal side. The resultant corneal exposure produces dryness and cortical keratitis. Many techniques have been described for correcting lagophthalmos in long-standing facial palsy. The aim of this report is to present some clinical experience using the ear cartilage graft for surgical treatment of lagophthalmos in facial palsy. The graft is sutured between the tarsal plate and the levator palpebrae superiorsis. The graft provides elongation of the levator muscle and also decreases its strength, since there is no opposing orbicularis oculi muscle. This technique offers a better dynamic, aesthetic and functional results, improving significantly the eye symptoms in cases of long-standing paralytic lagophthalmos. Some techniqual refinements will be described in this paper to avoid postoperative ptosis and to decrease the residual lagophthalmos