Sinha Kunal R, Rootman Daniel B, Azizzadeh Babak, Goldberg Robert A
Jules Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles.
Jules Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles2Doheny Eye Center, Division of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles.
JAMA Facial Plast Surg. 2016 Sep 1;18(5):379-84. doi: 10.1001/jamafacial.2016.0533.
Understanding the prevalence and clinical features of eyelid malpositions in facial nerve palsy (FNP) may inform proper management of patients with FNP and supplement our knowledge of eyelid physiology.
To describe eyelid malposition in FNP.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, patients with FNP seen at the Center for Advanced Facial Plastic Surgery and Jules Stein Eye Institute between January 1, 1999, and June 1, 2014, were reviewed for study inclusion. Data collection was performed between June 1, 2014, to August 1, 2014, and data analysis was performed between June 15, 2014, to September 1, 2015. The distances from the center of the pupil to the upper eyelid margin (marginal reflex distance 1 [MRD1]) and to the lower eyelid margin (marginal reflex distance 2 [MRD2]) were measured on photographs of patients in the primary position and with full smile. Eyelid asymmetry, retraction, ptosis, synkinesis, and severity and duration of FNP were assessed. Eligible participants were adults with FNP at a private tertiary care clinic with primary position photographs. Exclusion criteria included prior history of procedures or medical conditions that could alter eyelid position.
The 52 included patients were predominantly female (38 [73%]), with a mean (SD) age of 44.1 (13.8) years. Of this group, 34 patients (65%) were white, 8 (15%) were Asian, 8 (15%) were Hispanic, and 2 (4%) were African American. Retraction (MRD1, >5.0 mm) was present in 8 patients (15%), 3 of whom had eyelid asymmetry (MRD1, >1.0 mm). Overall, total asymmetry of greater than 1.0 mm was present in 14 patients (27%), with the FNP side higher in 12 (23%). Compared with those without asymmetry, patients with eyelid asymmetry were significantly more likely to have contralateral ptosis (42% vs 2.5%, P < .001) but did not have a significantly shorter duration of FNP (12.3 months vs 13.8 months, P = .82). Ptosis was noted in 4 patients and was also unrelated to duration of FNP (9.6 months in patients with ptosis vs 13.6 months in those without, P = .60). Synkinesis was found in 24 patients (46%), but none had concomitant ptosis. Severe FNP (House-Brackmann score, ≥4) was present in 28 patients (54%), and these patients were 20 times more likely to have asymmetry greater than 1.0 mm, often with the FNP side higher.
Upper eyelid asymmetry is common in FNP. In most of the patients in this study, the FNP side was higher without demonstrating retraction, and the contralateral side was ptotic. Thus, contralateral ptosis surgery may benefit these patients. Furthermore, patients with severe facial weakness were more likely to have eyelid asymmetry, suggesting that the ability of the eyelid position maintenance system to adapt to weakness of eyelid protractors may be limited by the severity of this weakness.
了解面神经麻痹（FNP）中眼睑错位的患病率和临床特征，可为FNP患者的恰当治疗提供依据，并补充我们对眼睑生理学的认识。
描述FNP中的眼睑错位情况。
设计、地点和参与者：在这项回顾性队列研究中，对1999年1月1日至2014年6月1日期间在高级面部整形手术中心和朱尔斯·斯坦因眼科研究所就诊的FNP患者进行了纳入研究的回顾。数据收集于2014年6月1日至2014年8月1日进行，数据分析于2014年6月15日至2015年9月1日进行。在患者处于原眼位和全力微笑时的照片上，测量从瞳孔中心到上睑缘（边缘反射距离1[MRD1]）以及到下睑缘（边缘反射距离2[MRD2]）的距离，并评估眼睑不对称、退缩、上睑下垂、联动以及FNP的严重程度和持续时间。符合条件的参与者为在一家私立三级医疗诊所患有FNP且有原眼位照片的成年人。排除标准包括有可能改变眼睑位置的既往手术史或疾病史。
纳入的52例患者中女性居多（38例[73%]），平均（标准差）年龄为……此处原文数字有误，正确应为44.1（13.8）岁。该组中，34例患者（65%）为白人，8例（15%）为亚洲人，8例（15%）为西班牙裔，2例（4%）为非裔美国人。8例患者（15%）存在上睑退缩（MRD1，>5.0 mm），其中3例有眼睑不对称（MRD1，>1.0 mm）。总体而言，14例患者（27%）存在大于1.0 mm的总不对称，其中12例（23%）FNP侧较高。与无不对称的患者相比，有眼睑不对称的患者更易出现对侧上睑下垂（42%对2.5%，P<0.001），但FNP的持续时间并无显著缩短（12.3个月对13.8个月，P = 0.82）。4例患者出现上睑下垂，且也与FNP持续时间无关（上睑下垂患者为9.6个月，无下垂患者为13.6个月，P = 0.60）。24例患者（46%）发现有联动，但均无合并上睑下垂。28例患者（5-此处原文数字有误，正确应为54%）存在严重FNP（House-Brackmann评分，≥4），这些患者出现大于1.0 mm不对称的可能性高20倍，且通常FNP侧较高。
上睑不对称在FNP中很常见。在本研究的大多数患者中，FNP侧较高但无退缩，对侧出现上睑下垂。因此，对侧上睑下垂手术可能使这些患者受益。此外，面部严重无力的患者更易出现眼睑不对称，这表明眼睑位置维持系统适应眼睑牵开肌无力的能力可能受该无力严重程度的限制。
3级。
