Occurrence and severity of upper eyelid skin contracture in facial nerve palsy

Abstract

Purpose To describe the occurrence and severity of upper eyelid skin contracture in facial nerve palsy (FNP). Methods We enroled consecutive patients with unilateral FNP into this study. Patients with previous upper eyelid surgery for either side were excluded. We developed a standardised technique to measure the distance between the upper eyelid margin and the lower border of brow (LMBD). FNP was graded using the Sunnybrook grading scale. Its aetiology, duration, and treatment were noted. Upper and lower marginal reflex distance and lagophthalmos were also noted. Results Sixty-six patients (mean age 51 years) were included. FNP was owing to a variety of aetiologies. LMBD on the paralytic side was shorter than the normal contralateral side in 47 (71%), equal in 15 (23%), and larger in four (6%) patients. The mean contracture was 3.4 mm (median: 3, range: 1-12) with 11 (17%) patients showing 5 mm or more of skin contracture. The mean LMBD on the paralytic side in all patients was significantly smaller than the contralateral side; 30 ± 3.7 (median: 30; 95% CI 29-31) compared with 32 ± 3.7 (median: 32; 95% CI 32-33), respectively, Po0.0001, two-tailed paired t-test. Conclusion To our knowledge, this is the first study that quantitatively demonstrates contraction of the upper eyelid skin in FNP. This finding is valuable in directing optimal early management to minimise skin contracture and to caution surgeons against unnecessary upper eyelid skin excision.

Functional and aesthetic outcomes of eyelid skin grafting in facial nerve palsy

“…Based on this theory, they have demonstrated a moderate to significant improvement in lagophthalmos in patients with FNP with manual stretching of the upper eyelid. It has been demonstrated that upper eyelid skin contracture is a frequently observed feature in patients with FNP and contributes to some degree in lagophthalmos 11. FTSGs can support contracted periocular skin and increase its surface area to improve lid position in patients with FNP.…”

“…A useful clinical method to help identify the presence of eyelid skin and middle lamella contraction is to assess the upper eyelid margin to brow distance (LMBD) 11 11. FTSGs provide an ancillary procedure to the current surgical armamentarium for patients with FNP where skin contraction exists.…”

“…However, despite a plenitude of published procedures, symmetry of eyelid position and acceptable closure are often short-lived or inadequate. These may be partly due to local atrophy of the muscle and soft tissue, including the skin, due to disuse or diminished activity 11. Furthermore, presumably due to muscle-pump paralysis, fibrosis of the subcutaneous tissue and trophic skin changes occur 12.…”

“…Furthermore, presumably due to muscle-pump paralysis, fibrosis of the subcutaneous tissue and trophic skin changes occur 12. Skin contraction is known to occur in up to 60% of patients with FNP 11. Failing to acknowledge its impact may contribute to early failure and poor outcomes.…”

Occurrence and severity of upper eyelid skin contracture in facial nerve palsy

“…In Occurrence and severity of upper eyelid skin contracture in facial nerve palsy, 1 Ziahosseini et al quantitatively demonstrates a shortening of the upper eyelid by a standardized measurement between the upper eyelid margin and the lower border of brow in 66 patients with facial nerve palsy. They explain these findings, seen in 71% of their patients, with contractions of the upper eyelid skin: local atrophy of muscle, and/or soft tissue could result from disuse or diminished activity caused by the palsy.…”