Minitendon graft transfer for suspension of the paralyzed lower eyelid: our experience.

ABSTRACT

BACKGROUND: Restoration of eyelid animation and aesthetics is a major component of the surgical management of facial paralysis. The authors' experience with the minitendon graft (a piece of split palmaris tendon graft) for lower eyelid suspension is presented. The effect of age, cause, denervation time, and total number of procedures performed in the eye region are analyzed. METHODS: Fifty-eight patients with facial paralysis presenting with paralytic ectropion received the minitendon graft for lower eyelid suspension. Twenty-eight patients with concurrent lagophthalmos received the eye spring (n = 14) or gold weight (n = 14). Scleral show and lagophthalmos were measured by the same investigator (S.A.K.) using the methodology established by Terzis and Bruno. Outcomes were graded as follows grade 1, no change; grade 2, minimal change; grade 3, moderate change; grade 4, good (more than half decrease); and grade 5, excellent, no scleral show or lagophthalmos. RESULTS: Seventy percent of the patients were female, and in 40 percent the cause was developmental. There was clear improvement in both scleral show and lagophthalmos (p < 0.001). More than 80 percent of the outcomes were graded as good to excellent for both scleral show and lagophthalmos. There was correlation between age and cause, but neither affected outcomes. Denervation time had no influence on the results (p = 0.942). CONCLUSION: The minitendon graft for lower eyelid suspension is an effective technique for repositioning the paralyzed lower eyelid regardless of patient age, denervation time, or cause of injury, and may be effectively combined with the eye spring or gold weight in the presence of lagophthalmos.