Golio Dominick, De Martelaere Sheri, Anderson James, Esmaeli Bita
Houston, Texas From the Section of Ophthalmology, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2007 Apr 1;119(4):1233-1237. doi: 10.1097/01.prs.0000254346.19507.e8.
Facial nerve paralysis is a common event in patients with head and neck cancer or metastasis of cancer to the parotid region. The aim of this study was to evaluate the outcomes of periocular reconstruction for facial nerve paralysis in cancer patients.
The medical records of all patients who had undergone periocular surgery for facial nerve paralysis between January of 1999 and December of 2003 were retrospectively reviewed. The outcome measures included the ocular symptoms and signs, improvement in symptoms of exposure keratopathy postoperatively, timing of periocular surgery in relation to radiotherapy, and surgical complications.
Preoperative symptoms included burning sensation (25 of 78 patients), difficulty with vision (30 of 78), frequent use of lubricating drops and ointments (52 of 78), and excessive tearing (37 of 78). The degree of lagophthalmos ranged from 1.5 to 12 mm (mean, 6.5 mm) preoperatively and from 0 to 4.5 mm (mean, 1.5 mm) postoperatively. Seventy-eight patients had gold weight placement; 72 of them also had lateral tarsorrhaphy, 56 had lower eyelid tightening via a lateral tarsal strip procedure in addition to the gold weight and lateral tarsorrhaphy, and 22 had brow elevation in addition to all the above-mentioned procedures. Four also required a medial tarsorrhaphy. All patients reported less dependence on lubricating drops and ointments after periocular surgery. Eighteen of 25 patients who had foreign body sensation as their main preoperative symptom experienced improvement after surgery. Forty-four patients had radiotherapy to the head and neck region. Twenty-seven patients completed radiotherapy before and 17 after periocular reconstruction. Complication rates were low and comparable in both preoperative and postoperative radiation groups.
Periocular reconstruction for facial paralysis results in improvement of exposure keratopathy and less dependence on lubricating drops and ointments. Complications are minimal and infrequent. The timing of external beam radiotherapy does not affect the outcomes of periocular surgery.
面神经麻痹在头颈癌患者或癌症转移至腮腺区域的患者中是常见情况。本研究的目的是评估癌症患者面神经麻痹的眼周重建效果。
回顾性分析1999年1月至2003年12月期间所有因面神经麻痹接受眼周手术的患者的病历。结果指标包括眼部症状和体征、术后暴露性角膜病变症状的改善情况、眼周手术与放疗的时间关系以及手术并发症。
术前症状包括烧灼感（78例患者中的25例）、视力障碍（78例中的30例）、频繁使用润滑滴眼液和眼膏（78例中的52例）以及流泪过多（78例中的37例）。术前睑裂闭合不全程度为1.5至12毫米（平均6.5毫米），术后为0至4.5毫米（平均1.5毫米）。78例患者植入了金片；其中72例还进行了外侧睑裂缝合术，56例除金片植入和外侧睑裂缝合术外，还通过外侧睑板条手术进行了下睑收紧，22例除上述所有手术外还进行了眉上提术。4例还需要进行内侧睑裂缝合术。所有患者术后报告对润滑滴眼液和眼膏的依赖减少。术前以异物感为主要症状的25例患者中，18例术后症状改善。44例患者接受了头颈部放疗。27例患者在眼周重建术前完成放疗，17例在术后完成放疗。术前和术后放疗组的并发症发生率均较低且相当。
面神经麻痹的眼周重建可改善暴露性角膜病变，减少对润滑滴眼液和眼膏的依赖。并发症极少且不常见。外照射放疗的时间不影响眼周手术的效果。
