title: Alternative surgical treatment of paralytic lagophthalmos using autogenic cartilage grafts and canthopexy.
abstract: OBJECTIVE
  This study aims to analyze the use of autogenic auricular cartilage grafts as weight for the upper eyelid in conjunction with lateral canthopexy for patients with mild paralytic lagophthalmos. This procedure was also accompanied by elevation of the lower eyelid using the cartilage graft for moderate cases.
  
  
  METHODS
  We conducted a retrospective study including case series of 30 patients with paralytic lagophthalmos from 1997 to 2010. For mild cases, cartilage from the auricular scapha was placed in pretarsal space of the upper eyelid and cartilage from the concha was inserted in preaponeurotic space and then sutured to the levator aponeurosis in conjunction with lateral canthopexy. For moderate cases, lower eyelid was also elevated by suturing cartilage graft to tarsum and resting it by the inferior orbital rim.
  
  
  RESULTS
  All patients had some degree of keratopathy before the intervention. After treatment, they presented with evident clinical improvement, reduction of eye symptoms, and resolution of keratopathy. During the mean postoperative follow-up of 37.3 months, none of the patients presented with cartilage graft exposition, reabsorption, visibility, infection, or warping. Complete eye closure was achieved in 24 (80%) patients, whereas the remaining 6 (20%) patients had residual asymptomatic lagophthalmos.
  
  
  CONCLUSIONS
  The intervention using autogenic auricular cartilage grafts explained in this study was only effective for the treatment of mild and moderate cases of paralytic lagophthalmos. This outpatient surgery is associated with low morbidity and achievement of functional and aesthetic improvement.
authors.affiliation: Division of Plastic Surgery, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Henri
authors.initials: H
authors.lastname: Friedhofer
authors.forename: Pedro Soler
authors.initials: PS
authors.lastname: Coltro
authors.forename: Aneta Hionia
authors.initials: AH
authors.lastname: Vassiliadis
authors.forename: Marcelus Vinícius
authors.initials: MV
authors.lastname: Nigro
authors.forename: Fábio Lopes
authors.initials: FL
authors.lastname: Saito
authors.forename: Tatiana
authors.initials: T
authors.lastname: Moura
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Faria
authors.forename: Marcus Castro
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D000368:Aged; D064592:Autografts / Q000637:transplantation*; D019882:Blepharoplasty / Q000379:methods*; D004425:Ear Cartilage / Q000637:transplantation*; D005141:Eyelid Diseases / Q000209:etiology / Q000601:surgery*; D005158:Facial Paralysis / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014182:Transplantation, Autologous; D016896:Treatment Outcome