Free functional platysma transfer for restoration of spontaneous eye closure in facial paralysis: an analysis of anatomy, imaging, and clinical outcomes.

Leckenby, Jonathan I; Patel, Alap U; Patel, Swapnil; Rahman, Akm A; Haque, Shameem; Grobbelaar, A O (2023). Free functional platysma transfer for restoration of spontaneous eye closure in facial paralysis: an analysis of anatomy, imaging, and clinical outcomes. Plastic and reconstructive surgery, 151(6), pp. 1296-1305. Wolters Kluwer 10.1097/PRS.0000000000010102

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BACKGROUND

Facial palsy patients suffer an array of problems ranging from functional to psychological issues. With regard to the eye, lacrimation, lagophthalmos and the inability to spontaneously blink are the main symptoms and if left untreated can compromise the cornea and vision. This paper reports the outcomes of 23 free functional vascularized platysma transfers used for reanimation of the eye in unilateral facial paralysis.

METHODS

Data was collected prospectively for all patients undergoing reanimation of the paralyzed eye using free functional platysma transfer. The only exclusion criterium was that a minimum of a two-year follow up was required. Patients were assessed pre- and post-operatively and scored using the eFACE tool focusing on eye-symmetry with documentation of blink reflex.

RESULTS

A total of 26 free functional platysma transfer were completed between 2011 and 2018; three patients were excluded due to inadequate follow up. The mean age was 9.1 years (SD 7.1) and a ratio of 12 males to 11 females. Pre-operatively no patients had evidence of a blink reflex in comparison to 22 patients at two-year follow up. There was a statistically significant improvement in palpebral fissure (p < 0.001) and full eye closure (p < 0.001) scores at two-year follow up however, there was no statistically significant difference in gentle eye closure (p = 0.15).

CONCLUSIONS

This is the first report of free functional platysma long-term outcomes in eye reanimation. The results demonstrate that successful restoration of the blink reflex can be achieved and full eye closure is obtainable following surgery.

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