New technique restores blink ability
Before and after surgery photos of a 44-year-old patient following removal of an acoustic neuroma. Prior to surgery she was unable to smile or close her eyes voluntarily. Two years after midface and eye surgery, she has a symmetric smile and can close her eyes voluntarily. Credit: UT Southwestern Medical Centre

New technique restores blink ability

August 3, 2020 Staff reporters

Using a cutting-edge techniqueTexas surgeons have restored the ability to blink and voluntarily close their eyes in patients with facial paralysisprotecting their corneas from the progressive damage typically seen in this group. 

 

The procedure, described in Plastic and Reconstructive Surgeryinvolves reinnervating the muscles around the eye that allow eye closure via a combination of techniques.  

 

Early intervention is key, said study lead, Professor Shai Rozen from the UT Southwestern Medical Centre (UTSW) in Dallas, who found that patients with facial paralysis for less than 18 months benefitted most from the new approach“Seeing patients early after the injury is very important. Many patients will improve on their own, but for those who don’t, time is critical. Loss of time means loss of muscle and, at a certain point, this loss is irreversibleThere’s this window of opportunity that we really want patients and physicians to be aware of.” 

 

Traditionally, surgeons implant gold or platinum weights to the upper eyelid and lift the lower eyelid, allowing patients passive closure of their eyes. This method provides corneal protection at night but less so during the day, when even the slightest wind or air conditioning causes dryness and discomfort, explained Prof Rozen 

 

The new method, performed on more than 40 patients at UTSW, involves reconnecting nerves back into the muscles around the eye, restoring the orbicularis oculi muscle 

 

For the studyProf Rozen and his team compared the outcomes of 11 UTSW facial paralysis patients who received the newer surgery with 16 who received the traditional method of gold weights in their eyelids.  

 

At 15 months after surgery, patients who had undergone muscle restorative surgery could close their eyes more than five times faster than before the surgery and 32.8% faster than patients with only gold weights. At 21 months post-surgery, 89% of patients in the first group could fully close their eyes, while only 7.1% of other patients could. Moreover, patients who had received the muscle restorative surgery had 67.9% less corneal damage.