Corneal neurotization: a novel technique for the anesthetic cornea.
OBJECTIVE
This report describes and evaluates the efficacy of a novel procedure, direct corneal neurotization using contralateral, supraorbital, and supratrochlear nerves in patients with unilateral facial palsy and corneal anesthesia.


METHODS
The charts of 6 patients were thoroughly reviewed. Evaluated outcome parameters included corneal sensibility, improvement in best-corrected visual acuity, blink reflex, donor deficit, synesthesia, long-term corneal health, several psychosocial measures, and overall patient satisfaction.


RESULTS
The mean age at time of surgery in our study was 41.7 +/- 9.07 years. Average time from denervation to surgery was 7.00 +/- 8.56 years with an average follow-up time of 16.3 +/- 2.42 years. After surgery, all 6 eyes showed improvement of corneal sensibility, visual acuity, and corneal health and remained free of ulcers without adjunctive surgical treatment. Average time to sensibility was 2.80 +/- 2.17 years, and average corneal sensibility improved from 2.00 +/- 4.47 mm before surgery to 27.8 +/- 22.6 mm after corneal neurotization (P < 0.016).


CONCLUSIONS
Direct neurotization of the cornea using the contralateral, supraorbital, and supratrochlear branches of the ophthalmic division of the trigeminal nerve seems to be an effective method for restoration of corneal sensibility in patients with unilateral facial palsy and anesthetic cornea. This procedure preserves ocular anatomy and cosmesis while restoring function by improving corneal health and visual acuity and by reestablishing the blink reflex.
Terzis
Julia K
JK
Microsurgical Research Center, International Institute of Reconstructive Microsurgery, Division of Plastic and Reconstructive Surgery, Department of Surgery, Eastern Virginia Medical School, Norfolk, VA 23501, USA. mrc@jkterzis.com
Dryer
Marylou M
MM
Bodner
Bruce I
BI
D000328:Adult; D003315:Cornea / Q000294:innervation*; D003316:Corneal Diseases / Q000601:surgery*; D003714:Denervation; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014276:Trigeminal Nerve / Q000601:surgery*; D014321:Trochlear Nerve / Q000601:surgery*; D014792:Visual Acuity; D055815:Young Adult