Evaluation of Residual Neuro-Muscular Integrity in the Orbicularis Oculi Muscle After Lower Eyelid Transcutaneous Blepharoplasty According to Reidy Adamson-s Flap (original) (raw)
Related papers
Annals of Plastic Surgery, 2001
Ectropion or scleral show resulting from weakness of the lower eyelids is not uncommon after lower blepharoplasty or midface lift via blepharoplasty incision. Denervation of the pretarsal orbicularis oculi muscle (OOM) attributes to such complications. The authors analyzed 102 patients who underwent midface lift via lower blepharoplasty incision for the past 3 years and investigated the motor nerve innervation of the lower OOM in 20 cadavers. They encountered two cases of ectropion attributed to the denervation of the pretarsal OOM: one with dry-eye syndrome and scleral show, and the other with a "polar bear-like appearance" (i.e., outer eversion of the lower eyelid). All pretarsal and preseptal OOMs were innervated by five to seven terminal twigs of the zygomatic branches of the facial nerve that approached the muscle at a right angle. The medial portion of the lower OOM was innervated by one to two terminal twigs of the buccal branch, and the middle portion was innervated with two to three twigs of the zygomatic branch. The lateral portion was supplied by the uppermost zygomatic branch, which split into two to four twigs. The mean horizontal distance between the lateral canthus and the zygomatic branch was 2.31 ؎ 0.29 cm (range, 1.7-2.7 cm) and the vertical distance was 1.20 ؎ 0.20 cm (range, 0.8-1.5 cm). The critical zone was a circle with 0.5-cm radius, and its center was located 2.5 cm inferolaterally (30 deg) from the lateral canthus. It is very important to understand the motor nerve innervation of the lower eyelid and the "critical zone" to avoid postoperative ectropion or weakness of the lower eyelid resulting from paralysis of the pretarsal or preseptal OOM.
Anatomical study of the variations in innervation of the orbicularis oculi by the facial nerve
Surgical and Radiologic Anatomy, 2004
While the divisions of the facial nerve in the face are well known, the innervation of the orbicularis oculi by the different distal branches of the facial nerve is poorly described. To determine which branches of the facial nerve play a role in this innervation, the facial nerve was dissected in 30 fresh cadavers. The innervation of this muscle was in the form of two plexuses, a superior one, most often (93%) formed by the union of the temporal and superior zygomatic branches, and an inferior one, usually formed (63%) by the union of the inferior zygomatic and superior buccal branches. This new mode of innervation explains how, without damage to both plexuses, innervation of orbicularis oculi by the facial nerve remains functional. It also explains the often unsatisfactory results of treatment of primary blepharospasm, and the unusual character of palsies of this muscle in cervicofacial lifts.
Ophthalmic Plastic & Reconstructive Surgery, 2011
Purpose: To compare the aesthetic outcomes of the upper blepharoplasty with or without resection of the preseptal orbicularis oculi muscle. Methods: An interventional randomized double-blind leftright study was conducted in 15 consecutive patients with dermatochalasis of the upper eyelid. One side was randomly chosen for resection of the preseptal orbicularis oculi muscle (group 1). The orbicularis oculi muscle of the contralateral side was preserved (group 2). All patients scored differences between both sides on the seventh day, the thirtieth day, and the ninetieth day after the surgery regarding the following symptoms: edema, hematoma, itching, and pain. Three masked ophthalmic plastic specialists analyzed the aesthetic outcomes by the visual analogical scale. Results: The scoring of symptoms was significantly higher in group 1 than in group 2 on the seventh postoperative day. On the thirtieth and ninetieth days, there were no significant differences between groups 1 and 2. The analysis by 3 masked observers showed that the aesthetic result was worse in group 1 than in group 2 on the seventh postoperative day. There were no significant differences between groups 1 and 2 on the thirtieth and ninetieth days. Conclusions: Upper blepharoplasty causes more postoperative symptoms and presents worse initial aesthetic outcome when the preseptal orbicularis oculi muscle is excised. However, the final aesthetic outcome is the same when the preseptal orbicularis oculi muscle is excised or preserved.
Aesthetic Plastic Surgery, 2019
Lower blepharoplasty is a challenging aesthetic procedure. Despite advances in clinical and neuroanatomical studies related to orbicularis oculi muscle innervation, no study has examined its histopathological aspects in different lower blepharoplasty procedures. This study aimed to assess changes in the pretarsal muscle complex in patients treated with transcutaneous lower blepharoplasty with orbicularis myotomy versus those treated with transconjunctival blepharoplasty without myotomy. Methods A total of 268 patients underwent blepharoplasty performed by a single surgeon: transcutaneous lower blepharoplasty in 112 (41.7%) and transconjunctival lower blepharoplasty with retroseptal access in 156 (58.2%). Subsequent minor blepharoplasty procedures were performed in 32 patients with lower pretarsal orbicularis oculi muscle biopsy. Connective tissue, fibrillar elastic system, nerves, blood vessels, fiber diameter, and sarcomeres were analyzed.
Resecting orbicularis oculi muscle in upper eyelid blepharoplasty – A review of the literature
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2010
Background: Blepharoplasty of the upper eyelids is one of the most commonly performed procedures in aesthetic plastic surgery. However, the rationale for muscle resection along with skin is uncertain. Methods: A PubMed search was performed using the following keywords: 'blepharoplasty' and 'muscle' as well as 'blepharoplasty' and 'orbicularis'. This yielded 419 different hits. All abstracts from English, Dutch, German or French papers were scanned for potential relevance; of which 59 papers were retrieved. The papers were considered to be relevant for our review if they described their technique for upper blepharoplasty and if they mentioned whether or not they resected orbicularis oculi muscle. Papers describing blepharoplasty combined with other surgical interventions were not included unless specific remarks about the blepharoplasty and the role of orbicularis resection were made. Studies describing a surgical technique specifically designed to create an epicanthal fold in Asians were excluded as well. Results: In total, 55 papers were included for review. Various reasons for muscle resection are described; most authors resect muscle without providing a reason to do so. In more recent literature, a trend towards muscle preservation is observed. Conclusions: A lack of consensus about what is to be done with the orbicularis oculi muscle in upper lid blepharoplasty is demonstrated. This amounts to a shortcoming, especially in training young plastic surgeons. Therefore, an algorithm is proposed.
Muscle & Nerve, 2009
We have shown that manual stimulation of rat whisker-pad muscles following facial-facial-anastomosis (FFA) restores normal whisking by lowering the proportion of polyinnervated motor endplates. Here we examined whether manual stimulation of the orbicularis oculi muscle (OOM) after FFA would also improve outcome. Blink responses to standardized air puffs were analyzed using video-based motion analysis. Two months after FFA, blink capacity was impaired, as indicated by a largely increased minimum distance between the eyelids after air-puff stimulation compared with intact rats (2.7 Ϯ 0.4 vs. 0.2 Ϯ 0.01 mm). Manual stimulation reduced this deficit by a factor of two (1.3 Ϯ 0.5 mm). The functional improvement after manual stimulation was associated with a 2-fold decrease in the proportion of polyinnervated OOM endplates (21 Ϯ 10% vs. 42 Ϯ 10% without manual stimulation, 0% in intact rats). We conclude that manual stimulation is a noninvasive and simple procedure with immediate potential for clinical rehabilitation of eyelid closure following facial nerve injury.
Upper Lid Blepharoplasty Without Cutting the Orbicularis Muscle
We have compared the aesthetic outcomes of upper blepharoplasty with or without resection of the preseptal orbicularis oculi muscle. In addition we evaluated MRI to visualize the differences in the upper eyelids before and after surgery. An interventional randomized double-blind left right study was conducted in 10 patients with upper eyelid dermatochalazis. One side was randomly chosen for incision of the preseptal orbicularis oculi muscle and direct coagulation or resection of fat pockets. The orbicularis oculi muscle of the contralateral side was not incised. Only a soft coagulation was performed on the muscle to induce a septal contraction and push the orbital fat back. All interventions were performed with an Ellman Dual frequency high frequency low temperature unit. Digital photos were taken before and after surgery and patients were asked to fill in a questionnaire to evaluate the surgery itself as well as the aesthetic outcome. In an attempt to objectify these findings, NMR imaging of the orbits was performed before and 6 weeks after surgery. Symptoms scoring was similar in both groups. At 6 weeks post-operation, no significant differences were observed between left and right eye. In conclusion, patients with dermatochalazis but without prominent fat prolapse in the upper eyelid, did not exhibit significant differences after cutting or not the orbicularis muscle to excise orbital fat. Even in cases with moderate fat prolapse, the fat can be pushed back by soft coagulation of the orbicularis and underlying orbital septum. When the preseptal orbicularis oculi muscle is preserved, the risk of hematoma and orbital cellulitis can be limited.
Plastic and Reconstructive Surgery – Global Open , 2018
The orbicularis oculi muscle (OOM) is sometimes incorporated with the superficial musculoaponeurotic system (SMAS) flap to provide a stronger flap. While elevating the OOM flap, it is important to avoid injury to the orbicularis branches of the zygomatic nerve. When the orbicularis branches of the zygomatic nerve are identified during the OOM-SMAS flap elevation, a transverse OOM flap was created to preserve the nerve. Postoperative follow-up was 12 months. There was no functional impairment of the OOM in the follow-up period. There are anatomical variations of the orbicularis branches of the zygomatic nerve. When it is identified, a transverse OOM flap incorporating it can be raised to avoid inadvertent injury. Using this method, good results were achieved with virtually no complications.
Electrical activity of the orbicularis muscles before and after installation of ocular prostheses
International journal of oral and maxillofacial surgery, 2015
This study examined the electrical activity of the superior (SO) and inferior (IO) orbicularis oculi muscles before and after installing ocular prostheses in patients who had undergone unilateral enucleation. Twelve volunteers requiring prostheses were selected. Their electrical activity was monitored at rest and during normal opening and closing of the eyelids, rapid opening and closing of the eyelids, and squeezing. Data were recorded before and 7, 30, and 60 days after the ocular prosthesis was installed. Two-way analysis of variance was performed to verify whether there were any significant differences between the muscles and periods, and means were compared by Tukey-Kramer honestly significant difference (HSD) tests (P<0.05). Results from the initial period differed significantly from those after prosthesis installation in all clinical situations. The SO had significantly higher electrical activity levels than the IO in all clinical situations but squeezing. The authors obse...