Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
Medical Center of Burn, Plastic Surgery and Wound Repair, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Aesthetic Plast Surg. 2024 Nov;48(21):4291-4298. doi: 10.1007/s00266-024-04241-5. Epub 2024 Aug 1.
Lower eyelid suspension, a common therapeutic procedure for facial paralysis-induced eyelid retraction, faces challenges due to high recurrence in patients lacking facial muscle function and impedes wider adoption. This research aims to explore the potential effects of restoring orbicularis oculi muscle tension through facial nerve reanimation prior to lower eyelid suspension and to define the indications for lower eyelid suspension.
The study encompassed 32 individuals with complete facial paralysis, segmented into group A (reanimation group) and group B (non-reanimation group), based on whether the orbicularis oculi muscle's tension was restored through facial nerve reconstruction prior to lower eyelid suspension. Subjective assessments of eyelid closure (the inter-eyelid gap upon gentle closure) and objective methods measures of scleral show (the distance from the pupil's center to the lower eyelid margin, MRD2) were used to provide a comprehensive analysis of long-term effectiveness.
The group A exhibited significantly greater long-term improvement in lagophthalmos and lower eyelid ectropion. The alterations in MRD2 measured 2.66 ± 0.27 mm in the group A versus 2.08 ± 0.53 mm in the group B, denoting a statistically significant variance (p < 0.001). Moreover, while the ratio of MRD2 preoperative 6 months postoperative revealed no significant difference between groups, a significant difference emerged in 12 months postoperative (group A: 1.02 ± 0.21; group B: 1.18 ± 0.24; p < 0.05), with the values in group A closer to 1, indicative of enhanced symmetry.
Restoring the tension in the orbicularis oculi muscle through facial nerve reconstruction prior to palmaris longus tendon sling could effectively sustain long-term outcomes of lower eyelid retraction correction and reduce the recurrence rate.
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下眼睑悬吊术是治疗面瘫引起的眼睑退缩的常用治疗方法，但对于缺乏面部肌肉功能的患者，其复发率较高，阻碍了其更广泛的应用。本研究旨在探讨面神经再兴奋前恢复眼轮匝肌张力对面瘫患者下眼睑悬吊术的潜在影响，并明确下眼睑悬吊术的适应证。
本研究纳入 32 例完全性面瘫患者，根据下眼睑悬吊术前是否通过面神经重建恢复眼轮匝肌张力将其分为 A 组（再兴奋组）和 B 组（非再兴奋组）。采用主观评估（轻闭眼时的睑裂间隙）和客观方法测量巩膜暴露度（瞳孔中心至下眼睑缘的距离，MRD2）对长期疗效进行综合分析。
A 组在治疗后上睑迟落和下睑外翻方面的长期改善效果显著优于 B 组。A 组的 MRD2 改变为 2.66 ± 0.27mm，B 组为 2.08 ± 0.53mm，差异有统计学意义（p < 0.001）。此外，两组患者术前 6 个月和术后 12 个月的 MRD2 比值差异无统计学意义，但术后 12 个月时差异有统计学意义（A 组：1.02 ± 0.21；B 组：1.18 ± 0.24；p < 0.05），A 组的值更接近 1，表明对称性更好。
通过掌长肌腱悬吊术前面神经重建恢复眼轮匝肌张力，可以有效维持下眼睑退缩矫正的长期效果，降低复发率。
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