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Outcomes From Lateral Eyelid Coupling for Facial Paralysis Using the Modified Tarsoconjunctival Flap.
JAMA Facial Plast Surg. 2018 Sep 01; 20(5):381-386.JF

Abstract

Importance

In the setting of facial paralysis, inadequate eyelid closure and lower eyelid ectropion can lead to corneal exposure and impaired quality of life. Repair of paralytic ectropion is challenging, and an ideal surgical approach for all cases has not been identified.

Objective

To assess the patient-reported outcomes and eyelid position improvement in patients with flaccid facial paralysis undergoing lateral eyelid coupling with a tarsal strip canthoplasty and modified tarsoconjunctival flap to correct eyelid malposition.

Design, Setting, and Participants

Review of medical records of adults with flaccid facial paralysis who underwent a single-stage tarsal strip canthoplasty and modified tarsoconjunctival flap at a tertiary academic center. Inclusion criteria included a minimum of 3 months of follow-up.

Intervention

The lateral upper and lower eyelid are coupled with the hybrid tarsoconjunctival flap.

Main Outcomes and Measures

Patient-reported outcome measures and objective photograph analysis. Preoperative and postoperative Facial Clinimetric Evaluation (FaCE) scores and Moe Ectropion Grading Scale scores were compared. The relationship between radiation therapy (RT) and outcomes was analyzed.

Results

Sixteen patients (8 [50%] female; mean [SD] age at surgery, 71.5 [9.6] years) were identified between January 2014 and August 2017. Twelve (75%) had paralysis from facial nerve sacrifice during cancer ablation. The mean time between paralysis and referral for surgical repair of ectropion was 23 months (range, 0-151 months) and mean follow-up after surgery was 9.8 months (range, 3-39 months). The most common symptom was epiphora, which was significantly reduced after surgery (75% vs 25%; P = .01). Median Moe Ectropion Grading Scale score improved from 3 (interquartile range, 2-3) to 0 (interquartile range, 0-1; P < .001). Quality of life measured using the FaCE scale demonstrated a significant improvement in mean eye comfort (from 18.8 [95% CI, 2.3-35.2] to 47.9 [95% CI, 31.9-63.9]; P = .01) and lacrimal control scores (from 12.5 [95% CI, 0-29.2] to 45.8 [95% CI, 29.3-62.3]; P = .03) in the 6 patients in the RT group, but no difference in the 4 patients in the non-RT group.

Conclusions and Relevance

Ocular symptoms, eyelid appearance, and quality of life were improved after lateral eyelid coupling among patients with flaccid facial paralysis and paralytic ectropion. The tarsoconjunctival flap does limit peripheral vision, but is reversible if dynamic eyelid closure is returned with nerve grafting.

Level of Evidence

4.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento.Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento.Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento.Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis.Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29621372

Citation

Dedhia, Raj, et al. "Outcomes From Lateral Eyelid Coupling for Facial Paralysis Using the Modified Tarsoconjunctival Flap." JAMA Facial Plastic Surgery, vol. 20, no. 5, 2018, pp. 381-386.
Dedhia R, Hsieh TY, Chin O, et al. Outcomes From Lateral Eyelid Coupling for Facial Paralysis Using the Modified Tarsoconjunctival Flap. JAMA Facial Plast Surg. 2018;20(5):381-386.
Dedhia, R., Hsieh, T. Y., Chin, O., Shipchandler, T. Z., & Tollefson, T. T. (2018). Outcomes From Lateral Eyelid Coupling for Facial Paralysis Using the Modified Tarsoconjunctival Flap. JAMA Facial Plastic Surgery, 20(5), 381-386. https://doi.org/10.1001/jamafacial.2018.0070
Dedhia R, et al. Outcomes From Lateral Eyelid Coupling for Facial Paralysis Using the Modified Tarsoconjunctival Flap. JAMA Facial Plast Surg. 2018 Sep 1;20(5):381-386. PubMed PMID: 29621372.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes From Lateral Eyelid Coupling for Facial Paralysis Using the Modified Tarsoconjunctival Flap. AU - Dedhia,Raj, AU - Hsieh,Tsung-Yen, AU - Chin,Oliver, AU - Shipchandler,Taha Z, AU - Tollefson,Travis T, PY - 2018/4/6/pubmed PY - 2019/9/21/medline PY - 2018/4/6/entrez SP - 381 EP - 386 JF - JAMA facial plastic surgery JO - JAMA Facial Plast Surg VL - 20 IS - 5 N2 - Importance: In the setting of facial paralysis, inadequate eyelid closure and lower eyelid ectropion can lead to corneal exposure and impaired quality of life. Repair of paralytic ectropion is challenging, and an ideal surgical approach for all cases has not been identified. Objective: To assess the patient-reported outcomes and eyelid position improvement in patients with flaccid facial paralysis undergoing lateral eyelid coupling with a tarsal strip canthoplasty and modified tarsoconjunctival flap to correct eyelid malposition. Design, Setting, and Participants: Review of medical records of adults with flaccid facial paralysis who underwent a single-stage tarsal strip canthoplasty and modified tarsoconjunctival flap at a tertiary academic center. Inclusion criteria included a minimum of 3 months of follow-up. Intervention: The lateral upper and lower eyelid are coupled with the hybrid tarsoconjunctival flap. Main Outcomes and Measures: Patient-reported outcome measures and objective photograph analysis. Preoperative and postoperative Facial Clinimetric Evaluation (FaCE) scores and Moe Ectropion Grading Scale scores were compared. The relationship between radiation therapy (RT) and outcomes was analyzed. Results: Sixteen patients (8 [50%] female; mean [SD] age at surgery, 71.5 [9.6] years) were identified between January 2014 and August 2017. Twelve (75%) had paralysis from facial nerve sacrifice during cancer ablation. The mean time between paralysis and referral for surgical repair of ectropion was 23 months (range, 0-151 months) and mean follow-up after surgery was 9.8 months (range, 3-39 months). The most common symptom was epiphora, which was significantly reduced after surgery (75% vs 25%; P = .01). Median Moe Ectropion Grading Scale score improved from 3 (interquartile range, 2-3) to 0 (interquartile range, 0-1; P < .001). Quality of life measured using the FaCE scale demonstrated a significant improvement in mean eye comfort (from 18.8 [95% CI, 2.3-35.2] to 47.9 [95% CI, 31.9-63.9]; P = .01) and lacrimal control scores (from 12.5 [95% CI, 0-29.2] to 45.8 [95% CI, 29.3-62.3]; P = .03) in the 6 patients in the RT group, but no difference in the 4 patients in the non-RT group. Conclusions and Relevance: Ocular symptoms, eyelid appearance, and quality of life were improved after lateral eyelid coupling among patients with flaccid facial paralysis and paralytic ectropion. The tarsoconjunctival flap does limit peripheral vision, but is reversible if dynamic eyelid closure is returned with nerve grafting. Level of Evidence: 4. SN - 2168-6092 UR - https://www.unboundmedicine.com/medline/citation/29621372/Outcomes_From_Lateral_Eyelid_Coupling_for_Facial_Paralysis_Using_the_Modified_Tarsoconjunctival_Flap_ L2 - https://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/10.1001/jamafacial.2018.0070 DB - PRIME DP - Unbound Medicine ER -