The management of the lower eyelid in facial paralysis (original) (raw)
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Appraisal of a modified medial canthal plication for treating laxity of the medial lower eyelid
Journal of Cranio-Maxillofacial Surgery, 2005
Purpose: The purpose of this study was to evaluate the efficacy of modified medial canthal tendon plication technique for correcting laxity of the medial end of the lower eyelid. Material and methods: Eleven patients (9 males and 2 females, 21 eyes), with an age range of 31-80 years, having laxity of the medial end of the lower lid of varying degrees were enrolled in this study. These patients presented with complaints of watering, recurrent redness, photophobia and foreign body sensation. After grading the amount of lower lid laxity, plication was performed. In patients in whom laxity was associated with ectropion, the severity of lower lid ectropion was also graded. In patients with ectropion of Grade II or more, additional procedures for its correction were performed before undertaking plication. The patients were followed up 6 months post-operatively and re-assessed for laxity, recurrence of symptoms and complications of plication. Results: All the lids were evaluated for the amount and extent of laxity of lower lid. Twelve (57%) eyes had Grade I, 9 (43%) had Grade II (and none Grade III) laxity of the lower lid. Twelve eyes had laxity restricted to the medial end and 9 eyes had laxity of the entire length of the lower lid. Some eyes also had an associated ectropion. Among the 21 eyes, 4 eyes (22%) had Grade 1, 11 (61%) had Grade 2, 6 (17%) Grade 3 and none Grade 4 ectropion. In the lids with associated ectropion, additional procedures had been performed. In 1 eye, the medial canthus was anchored to the tendon and this patient had poor apposition of the lower lid to the globe. Hence, in the remaining 20 eyes, the medial canthus was anchored to the orbital periosteum.
Lateral Canthal Support in Prevention of Lower Eyelid Malpositioning in Blepharoplasty
Journal of Craniofacial Surgery, 2015
Lower blepharoplasty is a cornerstone in facial rejuvenation and improvement. Despite its popularity, several adverse effects have been described; of these, postsurgical eyelid displacement, with its aesthetic and functional consequences, is one of the more frequent complications. The tarsal sling procedure is a simplified canthopexy
Plastic and Reconstructive Surgery, 2019
he tear trough ligament is the main anatomical basis for the tear trough deformity (Fig. 1). 1 Release of the tear trough ligament is a key maneuver for effective long-term correction of the tear trough deformity and is an essential step in many lower eyelid blepharoplasty techniques, whether performed by means of the transconjunctival or the subciliary approach. 2-16 The routine use of tear trough ligament release has been reported in many published blepharoplasty techniques, with good long-term results. 2-16 The released tear trough ligament is usually not reconstructed by resuspension or fixation. Indeed, it is necessary to prevent reattachment of the ligament to effectively correct the tear trough deformity. This is usually achieved by placing a soft-tissue spacer such as orbital fat pad transposition, septal reset, or maxillary augmentation with implants. 2-18
Aesthetic Plastic Surgery, 2012
Upper-eyelid blepharoplasty is a very common procedure in aesthetic plastic surgery. Among all the literature in favor of orbicularis muscle resection, there are no commentaries associated with orbicularis muscle suture and its convenience. This article discusses a new approach: independent resection of the orbicularis oculi muscle similar in size to the resected skin and the subsequent suture of the orbicularis muscle after its resection. This results in a fine reconstruction of the upper-eyelid crease, achieves a good definition of this anatomical structure, and allows correction of asymmetries with the contralateral upper eyelid. The results obtained (98 % of patients satisfied) and no complications with this procedure make it a safe alternative for upper blepharoplasty.
Transcaruncular Medial Canthal Ligament Plication for Repair of Lower Eyelid Malposition
Archives of Ophthalmology, 2007
To evaluate the long-term efficacy of transcaruncular medial canthal ligament (MCL) plication in the treatment of eyelid malposition. Methods: Transcaruncular MCL plication was performed on 176 eyelids of 125 patients with symptomatic ocular exposure due to lower eyelid malposition in which MCL laxity was an important component. Preoperative and postoperative ocular exposure symptoms, lower eyelid position, lagophthalmos, and keratopathy were compared. Results: At an average ± SD follow-up time of 25 ± 27 months (range, 1-103 months), 88% of preoperative symptoms resolved or improved. Lower eyelid position (PϽ.001), lagophthalmos (PϽ.001), and keratopathy (PϽ.001) were significantly improved. In 11% of eyelids undergoing MCL plication as the only repair, results were comparable with those in which other repairs were performed concurrently. Complications were suture breakage in 2 cases and pyogenic granuloma in 1 case. Conclusions: Transcaruncular MCL plication is a safe and effective technique for MCL laxity that contributes to lower eyelid malposition. This minimally invasive technique achieves good functional and cosmetic outcomes by re-establishing the vectoral forces for eyelid support that are normally provided by the tripartite ligament.
The muscle that primarly retracts the upper eyelid is called the levator palpebrae superioris muscle. For eyelid surgery, a thorough understanding of its anatomical and morphological variations as well as the variations of surrounding tissues is necessary. This study conducted on 100 adult orbits in Department of Anatomy, Istanbul University, used an exploratory, descriptive research design. Ethics committee approval was obtained from the Istanbul Medical Faculty Clinical Research Ethics Committee (date:31.03.2021; number:155281). The anatomical and morphological variations of levator palpebrae superioris muscle and its relationship with the superior ophthalmic vein were evaluated. Variations of levator palpebrae superioris muscle were discovered in 11 of 100 orbits. Single (9%), double (1%) and triple (1%) accessory muscle slips were observed. The variations associated with the superior ophthalmic vein were 5%. The origin of accessory muscle slips showed variation as the accessory ...