Korean Lepr Bull.  2023 Jun;56(1):1.

Surgical Procedure for lagophthalmos and ectropion during 30 years

• Ahn SY
• Park HJ

Abstract

Background
From May 1992 to the present, I(Ahn)have been in charge of reconstructive & restoration treatment for facial deformities and hand deformities once a week at a clinic affiliated with the Korea. Hansen Welfare Association for 30 years. The most common patients among these are those with lagophthalmos and ectropion. According to Kim Doil’s report 1 , the frequency of lagophthalmos is approximataly 20% in Korean leprosy patients. It occurs when eyes can’t close due to paralyis of the zygomatic branch of the facial nerve. Ectropion also appears as facial paralysis and due to senile change, which show relaxation of medial and lateral canthal tendons and sagging of the lower eye-lid itself. In 1988, there were about 25,000 registered patients with leprosy, but as of 2023, 8,100 people have been registered and the average age is 79 years old. There is a natural decline of approximately 500 people per year. It is calculated that there are still about 1,600 patients remaining with lagophthalmos. By reviewing 18 papers pubblished by the authors on our experience with plastic surgery treatment for lagophthalmos and ectropion over past 30 years, we hope th find better treatment methods in the future.
Objective
and Methods When I first started treating lagophthalmos in the early 1990s Temporalis transfer surgery(hereinafter called as TMT) was known to be the most effective method in the literature, so I started using this method for 2-3 years. But starting in 1980s, leperosy settlements on the outskirts gradually developed into cities, and leprosy patients who healed, came to live with the general pullic. As a result, the TMT surgery method, which shows the drawback of the phenomenon of eyelids closing at the same time on eating, was no longer preferred by patients. The author also looked for other surgical methods such as gold plate insertion, and levator and Muller muscle severing on the upper eyelid and lateral canthoplasty, horizontal shortening and canthal sling using deep fascia on the lower eyelid. However, as people age, this static method had a drawback in terms of sustainability of effect. The average age of papers published in 1995 was 50.7 years old, but in 2004 it was 61 years old and in 2014 the average was 70.1 years old and in 2022 the average age was 74.3 years old.
Results
Patients in there 50s and 60s who are socially active sought a cosmetically effective procedure with a shorter recovery period than TMT surgery, but patients over 70 years of age returned to TMT method which priorities functional aspects. The author also looked for a simple & effective modified TMT method using the deep fascia with less elevation of temporal muscle, but has now returned to the original Gillies-Anderson method, which modifying above method such as inserting temporal muscle obliquely into lateral canthal area about 15 degrees appropriate for the elderly and considering ways to fix fascia slip transplanted to the medial canthal area and prevent ptosis caused by fascia slip transplanted to the upper eyelid.
Conclusion
To reduce the recurrence of ectropion after TMT surgery, it is thought to be effective to perform lateral tarsal strip and sever the capsulo-palpebral fascia along with modified TMT as an auxiliary surgical method. To prevent of eye closing simultaneously with mastication, regular and steady chewing of gum or training to increase contact between the upper and lower teeth is recommended starting 3 weeks after TMT surgery.

Keyword

Lagophthalmos; Ectropion; Leprosy; Temporal muscle transfer