Korean Lepr Bull.  2022 Dec;55(1):.

How to treat the recurred ectropion and lagophthalmos after Temporal muscle transfer surgery.

• Ahn SY
• Park HJ

Abstract

Background
Among the aftereffects of facial paralysis in patients with a history of leprosy the biggest symptom is lagophthalmos. Long-term persistence of lagophalmos may eventually lead to blindness. Therefore it is the goal of doctors in charge of treating patients with leprosy to correct lagophthalmos. As of september 2022, there are about 8,200 people with a history of leprosy in South Korea. Their average age is 80.2 years old. There are no definite statisics as to what percentage of these people have lagophthalmos. The surest treatment to fix the lagophthalmos is Temporal muscle transfer(TMT).
Objective
and Methods Regarding this TMT the authors have tried to obtain effective surgical treatment result while reducing the side effects such as ptosis. 1,2 In the last 2 years, there were 11 cases of revision surgery due to recurrence of ectropion or lagophthalmos after TMT surgery. Since the average age of patients with a history of leprosy is 80.2 years old in South Korea. it seems necessary to perform TMT surgery at the sametime by considering the change of aging from the beginning. Medial canthopexy, permanent medial tarsorrhaphy and lateral canthoplasty including lateral tarsal strip were performed either single or both as needed.
Results
Since we abtained good results of improved ectropion and lagophthalmos by surgical of medial canthopexy, medial tarsorrhaphy & lateral canthoplasty performed as auxiliary procedures to TMT surgery, so we report it with a literature review.
Conclusion
In order to prevent the recurrence of ectropion or lagophthalmos after TMT surgery, not only conventional TMT surgery but also medial tarsorrphy, lateral canthoplasty including lateral tarsal strip as an auxiliary operation to TMT are performed for patient with a history of leprosy in South Korea whose average age is 80.2 years old. It is believed that adding and running these surgery from the beginning of TMT surgery will reduce the recurrence rate of ectropion and lapophthalmos. And when TMT muscle and fascia strip are inserted from the lateral to the lateral canthus, inserting then from a horizontal angle to the lateral superior direction(about 30 degrees) can be seen as one way to reduce recurrence.

Keyword

Lagophthalmos; Temporal muscle transfer; Medial and Lateral canthoplasty