title: Comprehensive midfacial elevation for ocular complications of facial nerve palsy.
abstract: BACKGROUND
  A chief morbidity of facial nerve palsy is ocular exposure, which is largely due to lower lid retraction and ectropion.
  
  
  OBJECTIVE
  To assess the role of midfacial elevation in the comprehensive surgical treatment of paralytic lower lid malposition and ocular exposure.
  
  
  METHODS
  Eleven patients with chronic facial nerve palsy causing symptomatic ocular exposure were treated with subperiosteal midface elevation as a component of comprehensive lower lid elevation. Other procedures were performed concomitantly to treat lower lid ligament laxity and reduced lower lid rigidity, as required. Preoperative and postoperative ocular exposure symptoms, visual acuity, lower lid position, lagophthalmos, and keratopathy were compared.
  
  
  RESULTS
  At an average of 17 months of follow-up, all patients reported improvement in symptoms. Visual acuity was maintained or improved in all patients. Lower eyelid position (P =.003), lagophthalmos (P =.07), and keratopathy (P<.001) were also improved.
  
  
  CONCLUSIONS
  Midfacial elevation is a safe and effective surgical adjunct in the treatment of lower eyelid retraction in chronic facial palsy. Its use reduces the need for tarsorrhaphy, which limits the binocular visual field and negatively impacts cosmesis.
authors.affiliation: Department of Ophthalmology, University of Michigan, Ann Arbor 48105, USA. velner@umich.edu
authors.forename: Victor M
authors.initials: VM
authors.lastname: Elner
authors.forename: Randy O
authors.initials: RO
authors.lastname: Mauffray
authors.forename: Robert G
authors.initials: RG
authors.lastname: Fante
authors.forename: Monte
authors.initials: M
authors.lastname: Harris
authors.forename: Asa D
authors.initials: AD
authors.lastname: Morton
authors.forename: Adam S
authors.initials: AS
authors.lastname: Hassan
mesh_terms: D000328:Adult; D000368:Aged; D004483:Ectropion / Q000209:etiology* / Q000503:physiopathology; D005143:Eyelids / Q000294:innervation / Q000503:physiopathology*; D005145:Face / Q000601:surgery*; D005154:Facial Nerve / Q000503:physiopathology*; D005158:Facial Paralysis / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged