The outcomes of dynamic procedures for blink restoration in pediatric facial paralysis.
BACKGROUND
Surgical planning aims to restore coordinated eyelid function. Although achieving voluntary eye closure is one of the primary goals, it cannot guarantee return of involuntary blink. Restoration of the afferent pathway of the reflex is a prerequisite, but successful coordination of the reflex components and restoration of their time-related function are also required.


METHODS
A retrospective review of 49 patients who underwent dynamic procedures for blink restoration was performed. The patients were divided into two groups. Group A (n = 42) included patients who underwent nerve transfers: cross-facial nerve grafting and subsequent microcoaptations, mini-hypoglossal nerve transfers, and direct orbicularis oculi neurotization. Group B (n = 14) included patients who underwent eye sphincter substitution techniques: pedicled frontalis, free platysma, mini-temporalis, and a slip of free pectoralis minor transfers. Seven of the patients included in the groups underwent both nerve and muscle transfer procedures. Objective blink ratios were measured according to an established protocol by the senior author (J.K.T.).


RESULTS
Thirty patients were girls and 19 were boys. The age of the patients ranged from 1 to 17 years, with a mean +/- SD age of 7.5 +/- 3.2 years. Denervation time ranged from 76 months to 15.25 years. Blink improvement was noted in all of the patients. Blink scores and ratios were consistently better in group A than in group B.


CONCLUSIONS
Dynamic procedures provide the functional potential on which subsequent static procedures can be performed to aid blink return, taking into account the future needs of the still growing patient.
Terzis
Julia K
JK
Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Microsurgery Program, Eastern Virginia Medical School.
Karypidis
Dimitrios
D
D000293:Adolescent; D001767:Blinking / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D005143:Eyelids / Q000294:innervation / Q000502:physiology; D005152:Facial Muscles / Q000294:innervation / Q000601:surgery; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery*; D007223:Infant; D008297:Male; D016067:Nerve Transfer; D019635:Neurosurgical Procedures; D010369:Pectoralis Muscles / Q000637:transplantation; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000502:physiology