Surgical treatment of lagophthalmos in facial palsy: ear cartilage graft for elongating the levator palpebrae muscle

Ocular exposure, conjunctival irritation and corneal keratitis are disturbing consequences of facial paralysis with lagophthalmos. Many techniques have been described for correcting this condition. A new method for decreasing the palpebral fissure is presented. An ear cartilage graft is interposed between the tarsal plate and the levator palpebrae superioris muscle. 12 patients with paralysis of the orbicularis oculi muscle, as assessed by electromyography, were treated with this technique. The palpebral fissure was decreased by 2–3 mm in all cases. 11 patients showed significant improvement of their eye symptoms. One patient, in whom the palpebral fissure could not be closed sufficiently to protect the eye, required additional lengthening by 4 mm of the cartilage graft and a lateral tarsorrhaphy.