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Fabiola Ogaz, Guillermo Salcedo, Ramiro Prieto, Ania Buigues, Linda Guakil; Lower eyelid surgical approach in facial paralysis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6375.
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Value the static techniques of facial reanimation lower eyelid with the most appropriate technique to restore functionality and aesthetic for each case, regardless of other changes also treated in the upper third.
Retrospective review of 37 patients suffering from facial paralysis and operated on the lower eyelid in the Asociacion para Evitar la Ceguera en Mexico (APEC) from 2006 to 2012. It has developed a descriptive statistical analysis and Kaplan Meier curves.
The mean age of the 37 patients was 58 years, predominantly in females. The most common etiology was idiopathic (37.8%), followed by trauma (32.4%) and neoplasms (16.2%). The main consulotation motives were keratitis (35.1%), corneal ulcer (24.5%) and epiphora (21.6%). 80% of patients presents paralytic ectropion 30% associated with the middle third decline, and 17% lagophthalmos. The surgical techniques employed were tarsal strip with or without periosteum hammock (35%) associated with the placement of a spacer (13.5%) associated with the lifting of the middle third (20.5%) or both (10.5%). In 8% used a permanent tarsorrhaphy in 5% canthoplasty. The results were a improvement of ocular exposure (81.1% lagophthalmos <2mm) and corneal changes (5% corneal erosion). 15 patients were operated jointly with gold weight. The symptoms disappeared in 57%, predominantly as epiphora and irritation major postoperative symptoms. The lagophthalmos improved by an average of 2.5mm and 1.75mm scleral exposure. Survival curves show a higher rate of complications in patients with tarsal strip technique isolate. The middle third approach, provides more time free survival in cases with associated bone suture and lower and lateral periosteum section
Facial paralysis can alter the functionality palpebral and limits corneal prtotection and the lacrimal drainage dynamics. With a chronic or irreversible facial paralysis, techniques described for the lower eyelid do not ensure a good functional and aesthetic recovery.
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