The vertical orbicularis oculi muscle turn-over procedure for the correction of paralytic ectropion of the lower eyelid

Background Static reconstruction surgery that tightens the tension of the inferior tarsus, thereby raising the lax lower eyelid, is a common treatment for paralytic ectropion of the lower eyelid. We present one such operative procedure, in which an orbicularis oculi muscle flap was used.

Methods The surgical technique involves partial resection of the tarsus and the skin, as well as a superior-based orbicularis oculi muscle flap that is sutured to the firm tissue present on the Whitnall tubercle. The muscle flap is approximately 7 mm in width and 15 mm in length, with a superior pedicle that is attached to the tarsus at the medial point of the resected tarsus. The procedure results in contact between the ocular surface and the lower eyelid.

Results The procedure was performed in 11 patients with lower eyelid ectropion due to facial paralysis. Ten cases showed a favorable outcome following surgery, with stable results seen over an average follow-up period of 4.5 years. In one case, recurrence of ectropion was observed 2 months after surgery due to an insufficient correction, and the patient required repeat surgery.

Conclusions The orbicularis oculi muscle flap was an effective means of suspension and was able to maintain long-term traction tension. This procedure can therefore be considered a favorable treatment option for lower eyelid ectropion due to facial paralysis.

Keywords

Eyelids - Facial paralysis - Ectropion - Reconstructive surgical procedures

Publikationsverlauf

Eingereicht: 28. Juli 2017

Angenommen: 20. Januar 2018

Artikel online veröffentlicht:
22. Mai 2022

• REFERENCES

• 1 Rahman I, Sadiq SA. Ophthalmic management of facial nerve palsy: a review. Surv Ophthalmol 2007; 52: 121-44
• 2 Carter SR, Chang J, Aguilar GL. et al. Involutional entropion and ectropion of the Asian lower eyelid. Ophthal Plast Reconstr Surg 2000; 16: 45-9
• 3 Smith B, Cherubini TD. Oculoplastic surgery: a compendium of principles and technique. Saint Louis: C.V. Mosby Company; 1970
• 4 Flowers RS, Duval C. Blepharoplasty and periorbital aesthetic surgery. In: Aston SJ, Beasley RW, Thorne CH. Grabb and Smith’s plastic surgery. 5th ed. New York: Lippincott Williams & Wilkins; 1997: 628-30
• 5 Anderson RL, Gordy DD. The tarsal strip procedure. Arch Ophthalmol 1979; 97: 2192-6
• 6 Becker FF. Lateral tarsal strip procedure for the correction of paralytic ectropion. Laryngoscope 1982; 92: 382-4
• 7 Jordan DR, Anderson RL. The lateral tarsal strip revisited: the enhanced tarsal strip. Arch Ophthalmol 1989; 107: 604-6
• 8 Andersen JG. Surgical treatment of lagophthalmos in leprosy by the Gillies temporalis transfer. Br J Plast Surg 1961; 14: 339-45
• 9 Frey M, Giovanoli P, Tzou CH, Kropf N, Friedl S. Dynamic reconstruction of eye closure by muscle transposition or functional muscle transplantation in facial palsy. Plast Reconstr Surg 2004; 114: 865-75
• 10 d’Alcontres FS, Cuccia G, Lupo F. et al. The orbicularis oculi muscle flap: its use for treatment of lagophthalmos and a review of its use for other applications. J Plast Reconstr Aesthet Surg 2010; 63: 416-22
• 11 Sevim KZ, Akcal A, Dagdelen D. et al. Beneficial effects of turnover orbicularis oculi muscle suspension flap for treating facial fractures via subciliary incision. J Craniofac Surg 2014; 25: 1465-7
• 12 Terzis JK, Kyere SA. Minitendon graft transfer for suspension of the paralyzed lower eyelid: our experience. Plast Reconstr Surg 2008; 121: 1206-16