Abstract Listings 2024

Purpose

To describe a complex mid face reconstruction in a patient with a history of left facial palsy in his childhood, who had undergone several previous failed restoring surgical procedures.

Methods

We report a four-in-one oculoplastic techniques used to reconstruct the upper and lower eyelids and the mid face in a patient who presented with partial extrusion of an upper eyelid gold weight, lower eyelid paralytic ectropion and severe lower fornix symblepharon secondary to previos surgery. The patient complained of chronic exposure keratopathy secondary to lagophthalmos despite wearing an upper eyelid weight, conjunctival adhesions that impeded abduction of his left eye, severe paralytic ectropion and mid face atrophy. A combination of different techniques was used: removal of the upper eyelid weight and levator muscle rehabilitation, lower eyelid suspension to orbital rim using ‘fascia lata sling’ technique, release of conjunctival adhesions and reconstruction of lower fornix with amniotic membrane, and mid face restoration using an autologous graft.

Results

At the conclusion of the case, normal eyelid dynamics were restored. Three months after the procedure, our patient remains able to open and close his eyes normally, exposure keratopahty is absent as no lagophthalmos is present, and volume of the mid face has been recovered.

Conclusion

A facial palsy can have a devastating effect on a patient. It is associated with a number of potential complications that need to be addressed on an individual basis. Restoring all of them in a single surgical time can be challenging, so having a deep knowledge of peri ocular area anatomy and dynamics remain imperative to avoid future complications and re-interventions.

Additional Authors

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