title: Transcaruncular medial canthal tendon plication with lower eyelid suture sling in facial nerve palsy.
abstract: OBJECTIVE
  To report a technique for correcting lower eyelid punctal ectropion with an inferiorly displaced or retracted medial eyelid due to facial nerve palsy, by extending a suture sling along the pre-tarsal lower eyelid when performing transcaruncular medial canthal tendon plication.
  
  
  METHODS
  Single-centre retrospective, non-comparative review of patients with facial nerve palsy who underwent medial canthal tendon plication with lower eyelid suture sling (MCT suture sling). Outcome measures included: the presence of lower eyelid ectropion, medial eyelid height, punctal position, inferior marginal reflex distance (MRD) and inferior scleral show measured both pre-operatively and at the last follow-up visit.
  
  
  RESULTS
  Thirty-three patients with facial nerve palsy with a mean age of 59, underwent MCT suture sling for lagophthalmos and/or ectropion. Then, 66% (21/32) of cases had punctal ectropion pre-operatively and 9% (3/32) had punctal ectropion at the last follow-up. Medial eyelid height was deemed to improve in 66% (21/32) of cases at the last follow up visit. Follow-up was mean 13.5 months. Six (18%) patients were deemed failures due to inferior MRD and inferior scleral showing worse than pre-operative measurements.
  
  
  CONCLUSIONS
  We report a technique for incorporating a suture sling to transcaruncular-approach MCT plication when the medial canthus has retracted or descended thus requiring support and a posterior vector. It avoids rounding of the medial canthal angle that may occur with traditional medial canthoplasty. Transcaruncular MCT plication is well described. Incorporating a suture sling to potentially reduce single point-fixation cheese-wiring and early dehiscence is minimally invasive, non-excisional and repeatable.
authors.affiliation: Corneoplastic Unit, Queen Victoria Hospital , East Grinstead , UK .
authors.forename: Mano
authors.initials: M
authors.lastname: Sira
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Norris
authors.forename: Charles
authors.initials: C
authors.lastname: Nduka
authors.forename: Raman
authors.initials: R
authors.lastname: Malhotra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004483:Ectropion / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005154:Facial Nerve / Q000503:physiopathology / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques; D013710:Tendons / Q000601:surgery*