Korean Lepr Bull.  2021 Dec;54(1):.

How to secure the fascial slip of Temporalis transfer to medial canthal tendon performed only on the lower eyelid for the treatment of lagophthalmos.

• Ahn SY
• Kim Jp
• Park HJ

Abstract

Background
Lagophthalmos, commonly seen in leprosy patients is an eye change that occurs when the zygomatic branch of the facial nerve is paralyzed and the orbicularis oculi muscle which is innervated by this nerve fails to close the eyes. Lagophthalmos usually occurs in one or both eyes, but Temporal muscle transfer (TMT) has been known as the most effective treatment for this lagophthalmos.However, the biggest side effect is ptosis caused by the fascial slip of the temporal muscle inserted into the upper eyelid
Objective
In order to prevent this occurrence of ptosis, the authors tried the Temporal muscle transfer surgery method only on the lower eyelid, with a gold plate implanted on the upper eyelid. In Temporal muscle transfer, when the fascial slip from the lower eyelid is fixed at the medial canthus, if there is no facial slip from the upper eyelid, there is no other tissue to pull and fix. When temporal muscle transfer is performed only on the lower eyelid, it is more difficult to completely close lagophthalmos than when both sides are performed However, there is also a report that it is difficult to cause corneal dryness in case with lid-gap less than 3mm.
Methods
In the past 2 years(2020-2021) the authors performed Temporalis transfer surgery alone on the lower eyelid in 17 cases of 12 patients of lagophthalmos and gold plate implantation in the upper eyelid in 6 cases with lid-gap of 4mm or more.
Results
After surgery, lid-gap was found: 0mm is 2 cases, 2mm is 3 cases, 3mm is 6 cases, 4mm is 5 cases, 5mm is 1 cases. Severe eye pain, common in lagophthalmos patients before Temporalis transfer surgery completely disappeared in all cases after surgery.
Conclusion
When treating lagophthalmos with Temporalis transfer method of the lower eyelid alone, it was possible to make a lid-gap of 3mm or less by making a fine tunnel from the lateral canthus to the medial canthus and by properly performing the method when securing the fascia slip to the medial canthus.

Keyword

Lagophthalmos; Leprosy; Medial canthal tendon; Temporal muscle transfer