title: Occurrence and severity of upper eyelid skin contracture in facial nerve palsy.
abstract: PurposeTo describe the occurrence and severity of upper eyelid skin contracture in facial nerve palsy (FNP).MethodsWe enroled consecutive patients with unilateral FNP into this study. Patients with previous upper eyelid surgery for either side were excluded. We developed a standardised technique to measure the distance between the upper eyelid margin and the lower border of brow (LMBD). FNP was graded using the Sunnybrook grading scale. Its aetiology, duration, and treatment were noted. Upper and lower marginal reflex distance and lagophthalmos were also noted.ResultsSixty-six patients (mean age 51 years) were included. FNP was owing to a variety of aetiologies. LMBD on the paralytic side was shorter than the normal contralateral side in 47 (71%), equal in 15 (23%), and larger in four (6%) patients. The mean contracture was 3.4 mm (median: 3, range: 1-12) with 11 (17%) patients showing 5 mm or more of skin contracture. The mean LMBD on the paralytic side in all patients was significantly smaller than the contralateral side; 30±3.7 (median: 30; 95% CI 29-31) compared with 32±3.7 (median: 32; 95% CI 32-33), respectively, P<0.0001, two-tailed paired t-test.ConclusionTo our knowledge, this is the first study that quantitatively demonstrates contraction of the upper eyelid skin in FNP. This finding is valuable in directing optimal early management to minimise skin contracture and to caution surgeons against unnecessary upper eyelid skin excision.
authors.affiliation: Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK.
authors.forename: K
authors.initials: K
authors.lastname: Ziahosseini
authors.affiliation: Department of Therapy, Queen Victoria Hospital, East Grinstead, UK.
authors.forename: V
authors.initials: V
authors.lastname: Venables
authors.affiliation: Department of Therapy, Queen Victoria Hospital, East Grinstead, UK.
authors.forename: C
authors.initials: C
authors.lastname: Neville
authors.affiliation: Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK.
authors.forename: C
authors.initials: C
authors.lastname: Nduka
authors.affiliation: Moran Eye Centre, University of Utah, Salt Lake City, UT, USA.
authors.forename: B
authors.initials: B
authors.lastname: Patel
authors.affiliation: Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK.
authors.forename: R
authors.initials: R
authors.lastname: Malhotra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003286:Contracture / Q000175:diagnosis / Q000209:etiology*; D003430:Cross-Sectional Studies; D003941:Diagnostic Techniques, Ophthalmological; D005133:Eye Movements; D005141:Eyelid Diseases / Q000175:diagnosis / Q000209:etiology*; D005155:Facial Nerve Diseases / Q000150:complications; D005158:Facial Paralysis / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000175:diagnosis / Q000209:etiology*