三联术治疗重度周围型面瘫相关眼部损害分析

Application of a Tri-procedure in the treatment of facial nerve paralysis related ocular lesions

目的探讨三联手术即眉下垂矫正联合外侧睑板悬吊和面中部提吊治疗重度周围型面瘫合并眉下垂、下睑外翻等相关眼部损害的方法及疗效。方法对2010年7月至2012年7月在福建医科大学附属第二医院眼科就诊的14例14只眼重度周围型面瘫，均为老年患者，面瘫严重程度达House—BrackmannV级到Ⅵ级，男8例，女6例；平均年龄（70±8．3）岁，面瘫发生时间2年到10年。诉患侧眼红、痛、畏光及干涩不适。患侧面部运动消失，皮肤及皮下组织松弛，额纹消失，眉下垂，眼睑皮肤松弛，下睑外翻，闭眼不全，球结膜充血，角膜上皮粗糙，荧光素染色（＋）。手术方法，采用眉下垂矫正联合外侧睑板悬吊和面中部提吊术。结果14例患者手术无并发症，术后眉下垂、下睑外翻完全矫正，1~2周内角膜染色转阴，外观改善。随访6个月至2年，2例患者眉下垂和下睑外翻复发但程度较术前轻。结论重度老年面瘫患者发生眉下垂、下睑外翻、角膜上皮损害等相关眼部损害，采用三联术可得到解剖和功能上的恢复。

Objective To evaluate the indication, methods and efficacy of the tri-procedure which includes correction of eyebrow ptosis combined with lateral tarsal strip procedure and midface lifting in the treatment of severe peripheral facial nerve paralysis related ocular lesions. Methods Fourteen patients whose facial nerve paralysis severity ranged from grade V to grade Vl according to House-Brackmann Facial Nerve Grading System were included in this prospective case control study. There were 8 males and 6 females with the average age of 70~8.3 years. Their related ocular lesions had lasted from two to ten years. The major complaint included red eye, pain in the eye, photophobia, dry eye and poor appearance. Physical check-up showed ipsilateral facial skin and sub- cutaneous tissue relaxation, disappearance of ipsilateral forehead lines, brow ptosis, eyelid skin laxity, lower lid ectropion, conjunctival hyperemia, and corneal epithelium lesions with positive fluorescein staining under a slit lamp. Correction of eyebrow ptosis, combined with lateral tarsal strip procedure and midface lifting were performed. Results No postoperative complications occurred. After the pro- cedure, eyebrow ptosis, lower lid ectropion were completely corrected, and corneal staining became negative in one or two weeks. During the 6 months to 2 years follow-up time, brow ptosis and ec- tropion recurred in 2 cases with a less severe degree. Conclusions Facial nerve paralysis relates oc- ular lesions in elderly patients, such as brow ptosis, ectropion, corneal epithelial damage cause both ocular surface problems as well as cosmetic problems. Application of surgical approach including brow ptosis correction combined with lateral tarsal strip procedure and midface lifting can alleviate the patients anatomically and functionally.