Orbicularis Oculi Muscle Reinnervation Confers Corneal Protective Advantages over Static Interventions Alone in the Subacute Facial Palsy Patient.

Tytuł:: Orbicularis Oculi Muscle Reinnervation Confers Corneal Protective Advantages over Static Interventions Alone in the Subacute Facial Palsy Patient.
Autorzy:: Mohanty AJ; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology, University of Texas Southwestern Medical Center.
Perez JL; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology, University of Texas Southwestern Medical Center.
Hembd A; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology, University of Texas Southwestern Medical Center.
Thrikutam NP; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology, University of Texas Southwestern Medical Center.
Bartley J; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology, University of Texas Southwestern Medical Center.
Rozen SM; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology, University of Texas Southwestern Medical Center.
Źródło:: Plastic and reconstructive surgery [Plast Reconstr Surg] 2020 Mar; Vol. 145 (3), pp. 791-801.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: : Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Baltimore : Williams & Wilkins,
MeSH Terms:: Corneal Diseases/*prevention & control
Facial Muscles/*innervation
Facial Nerve Diseases/*surgery
Facial Paralysis/*surgery
Nerve Transfer/*methods
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blinking/physiology ; Child ; Cornea/diagnostic imaging ; Cornea/pathology ; Corneal Diseases/diagnosis ; Corneal Diseases/etiology ; Corneal Diseases/physiopathology ; Eyelids/physiopathology ; Eyelids/surgery ; Facial Muscles/surgery ; Facial Nerve/surgery ; Facial Nerve Diseases/complications ; Facial Paralysis/etiology ; Female ; Humans ; Male ; Mandibular Nerve/transplantation ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult
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Entry Date(s):: Date Created: 20200226 Date Completed: 20200625 Latest Revision: 20211123
Update Code:: 20240105
DOI:: 10.1097/PRS.0000000000006608
PMID:: 32097327
: Czasopismo naukowe

Background: Corneal protection is a priority in flaccid facial palsy patients. Denervation of the orbicularis oculi muscle results in weak palpebral closure and predisposes patients to severe corneal sequelae. While periorbital static procedures enhance corneal coverage in repose, voluntary closure is only regained through dynamic reinnervation of the muscle. This study aims to elucidate the added effect of dynamic reinnervation of the orbicularis oculi muscle on long-term corneal integrity as well as on dynamic closure of the palpebral aperture.
Methods: Retrospective review was performed on two groups of complete palsy patients: those who received solely periorbital static procedures and those who underwent concomitant orbicularis oculi muscle reinnervation and static lid procedures. Only patients with complete ophthalmic examinations were included. Corneal punctate epithelial erosions in addition to static and dynamic palpebral measurements were serially assessed preoperatively and postoperatively.
Results: Of 272 facial palsy patients, 26 fit the inclusion criteria. Eleven patients underwent combined muscle reinnervation involving facial-to-masseteric nerve coaptation in addition to static eye procedures, and 15 patients underwent solely static interventions. Analysis revealed a 65.3 percent lower mean punctate epithelial erosion score in reinnervation patients as compared with static patients when evaluated at more than 9 months postoperatively (p < 0.01). Reinnervation patients were also found to have 25.3 percent greater palpebral aperture closure (p < 0.05) and 32.8 percent higher closure velocity (p < 0.01) compared with static patients.
Conclusion: In patients with subacute facial palsy, dynamic reanimation of the orbicularis oculi muscle with concomitant static interventions provides lasting corneal protection not seen in patients who receive solely static interventions.
Clinical Question/level of Evidence: Therapeutic, III.

Comment in: Plast Reconstr Surg. 2021 Feb 1;147(2):356e-357e. (PMID: 33177443)
Comment in: Plast Reconstr Surg. 2021 Feb 1;147(2):356e. (PMID: 33177447)
Comment in: Plast Reconstr Surg. 2021 May 1;147(5):1245-1247. (PMID: 33890914)

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