Bhagwati Wadwekar

Abstract

Aberrant facial nerve regeneration (AFR) is not well recognized as a cause of pseudoptosis. Signs of AFR includes pseudoptosis, narrow palpebral aperture and prominent nasolabial fold on side of paralysis. We present a series of six cases who had a significant pseudoptosis after facial nerve paralysis (FNP). All patients had a prominent nasolabial fold on the side of paralysis and a narrow palpebral aperture which further narrowed on the jaw movements. Margin Reflex distance (MRD)1 and MRD2 were reduced in all cases on the side of FNP. Levator palpebrae superioris (LPS) action and Bell’s phenomena were good in all the cases. All the cases were diagnosed as old lower motor neuron FNP with pseudoptosis due to AFR. In conclusion, AFR as a cause of pseudoptosis is less well recognized. It is important to keep in mind this entity for proper management and to prevent the patient’s dissatisfaction. Keywords: Aberrant facial nerve regeneration, Eyelid, Martin-Amat Syndrome, Ptosis, Marcus-Gunn jaw winking, Synkinesis.

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Abstract

Purpose: This study aims to analyze the impact of complete excision of posterior remnant tissue (ExPRT) on outcome of modified single anterior flap external dacryocystorhinostomy (mSAF-EDCR). Materials and Methods: We analyzed records of all patients who had undergone mSAF-EDCR with complete ExPRT between August 2014 and October 2016. We also noted operative time, complications and surgical outcome of these patients. Results: Forty-one patients had undergone mSAF-EDCR with complete ExPRT. Average surgical time was 36 minutes (range 28 to 50). The most common complications were intraoperative bleeding in four cases and torn sac flap in two cases, laceration of nasal mucosa in one case and extension of skin incision in one case. Follow-up was done at tenth day and one month post-operatively. There was complete absence of watering in 36 patients and occasional watering in five patients. Tear meniscus height was normal for all patients. Syringing was patent in all 41(100%) patients. Hence both subjective and objective success rates were 100%. Conclusions: Our series of cases mSAF-EDCR demonstrated 100% success rate which may be attributed to complete ExPRT. Our study also indicates that mSAF-EDCR is technically easier and time saving, and should be preferred over conventional EDCR. The complications related to flap damage are also more easily manageable in mSAF-EDCR than conventional EDCR. These results also prompt future research to assess complete ExPRT during mSAF-EDCR surgery. Keywords: Dacryocystitis, Epiphora, Lacrimal, Lacrimation, Nasolacrimal duct.

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