Oculoplastic surgical techniques for protection of the eye in facial nerve paralysis

To describe an algorithm for medical and surgical management of corneal exposure secondary to seventh cranial nerve paresis.

A retrospective review of 54 patients requiring surgical intervention for seventh cranial nerve paresis was performed.

Patients underwent outpatient procedures at a tertiary care facility.

31 men and 23 women, with a mean age of 55.7 years, were included in this study. They included 45 patients with involvement of the facial nerve at the time of surgery, 3 with inflammatory processes, 2 with central palsies, 1 with a traumatic paralysis, and 3 with idiopathic palsies. All 54 patients were treated both medically and surgically. Fifty-two patients underwent gold weight placement, and 39 patients underwent surgical repositioning of their lower eyelids; 24 of those patients had supplemental ear cartilage grafts inserted as well. Five patients had brow ptosis repairs, and 13 had tarsorrhaphies (9 temporary and 4 permanent). Twelve patients had confluent epithelial defects of >50% of their corneal surface, and 33 patients had smaller disruptions of their corneal epithelium. Three patients had minor complications secondary to surgical intervention. Thirty-seven patients had isolated seventh nerve palsies, and 17 patients also had fifth nerve pareses affecting their ocular surfaces. The average preoperative lagophthalmos was 6.3 mm, and the average postoperative lagophthalmos after all ocular procedures was 1.6 mm. The mean follow-up time was 19.7 months.

Treatment options for seventh cranial nerve deficits are reviewed. A decision-making process for the treatment steps is proposed and analyzed.