Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy.
Division of Oral and Maxillofacial Surgery, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Italy.
Cornea. 2023 Jan 1;42(1):121-126. doi: 10.1097/ICO.0000000000003126. Epub 2022 Aug 24.
No specific interventions have been reported for the treatment of severe neurodeprivative dry eye disease owing to facial nerve palsy. We describe herein the feasibility of a novel surgical procedure to reinnervate the lacrimal gland and report the preliminary outcomes of the first series of patients who were treated accordingly.
Prospective interventional case series including consecutive patients affected by facial palsy with absolute deficiency of tear secretion who underwent lacrimal gland neurotization. A sural nerve vertical cross-face graft was used to connect the lacrimal gland with the parasympathetic branch of the lingual nerve directed to the contralateral submandibular gland.
Lacrimal neurotization was performed uneventfully in 10 patients (4 M, 6 F; mean age 47.1 ± 17.1 years). In all cases, the procedure was combined with facial reanimation, while corneal neurotization was performed in 4 cases. One year postoperatively, mean values of a Schirmer test increased significantly compared with baseline values (7.56 ± 7.84 vs. 0 ± 0 mm/5 min; P = 0.02), while the mean daily number of instillation of tear substitutes decreased significantly (21.8 ± 4.5 vs. 7.1 ± 2.2; P = 0.009). Overall, all patients were satisfied with surgery (very satisfied: n = 7 and satisfied: n = 2). No major postoperative complications occurred.
Vertical cross-face using a sural nerve graft to connect the lacrimal gland with the contralateral submandibular gland is a novel technique for treating patients with facial nerve palsy and severe neurodeprivative dry eye disease. This surgery both performed alone and combined with corneal neurotization is able to improve tear secretion and decrease the need for frequent instillations of tear substitutes.
由于面神经麻痹导致严重的神经营养性干眼症，目前尚无特定的干预措施用于治疗。我们在此描述了一种新型手术方法来重新支配泪腺的可行性，并报告了首批接受相应治疗的患者的初步结果。
前瞻性干预性病例系列研究，纳入了 10 例因面瘫导致泪液分泌绝对缺乏的患者。使用腓肠神经垂直面交叉移植术将泪腺与舌下神经的副交感分支连接起来，该分支通向对侧颌下腺。
10 例患者（4 例男性，6 例女性；平均年龄 47.1 ± 17.1 岁）顺利完成了泪腺神经再支配。所有患者均同时进行了面神经再神经化，4 例同时进行了角膜神经化。术后 1 年，Schirmer 试验的平均值与基线值相比显著增加（7.56 ± 7.84 与 0 ± 0 mm/5 min；P = 0.02），而每天滴眼次数显著减少（21.8 ± 4.5 与 7.1 ± 2.2；P = 0.009）。总体而言，所有患者对手术均满意（非常满意：n = 7；满意：n = 2）。无重大术后并发症发生。
使用腓肠神经移植术垂直交叉将泪腺与对侧颌下腺连接起来，是治疗面神经麻痹和严重神经营养性干眼症患者的一种新方法。这种手术单独或与角膜神经化联合应用，均能改善泪液分泌并减少频繁滴眼的需求。
