Blepharoptosis Following Surgery for Facial Paralysis

Although various well-known forms of blepharoptosis have been reported, there is no report arguing blepharoptosis following the surgery for facial paralysis. A 40-year-old woman with unilateral facial paralysis secondary to mastoidectomy 20 years ago was admitted with her left upper eyelid ptosis. It was found that a free muscle grafting with tendon had been done to treat the complication. A Z-plasty was done to elongate the short tendon by 7 mm under general anesthesia. For reconstructing the mouth corner, a superiorly based sternocleidomastoid muscle flap was transferred after 3 months of the Z-plasty on tendon. The ptosis disappeared soon after Z-plasty surgery on the tendon. The patient learned how to use the newly transferred muscle for the mouth corner movements in 3 months. The problem associated with the presented case is rare, which included facial paralysis followed by blepharoptosis. This is a paradoxical situation. In other words, first, there is a possiblity of having blepharoptosis in a patient with facial paralysis that is already operated on. Second, it might be an intricate problem and I would like to discuss it. Last but not least, it is an example of paradox existing in medicine.