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Correction of Ectropion in Facial Paralysis


Hayashi, Akiteru M.D.; Maruyama, Yu M.D.

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Plastic and Reconstructive Surgery: April 1, 2006 - Volume 117 - Issue 4 - p 1351
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We thank Dr. Uraloglu and his colleagues for the attention they gave to our article.1 We agree with their comments that inorganic materials would increase the risk of infection. Actually, one of our patients developed a suture abscess in the medial region of the lower eyelid, but infection was healed after simple removal of the nonabsorbable suture. Six months later, the same procedure was successfully reperformed in this patient. We assessed this case as an accidental incident. There were no other acute or chronic reactions around the anchor in our series.

Dr. Uraloglu and his colleagues advised attention to the possible weakness of bony fixation on long-term follow-up of 5 to 10 years, metallic corrosion, and possible osteoporosis in elderly patients. These subjects should be analyzed later using patients who have appeared in the literature.2–4 In our clinical series, four patients had been followed for more than 2 years at the time our article was prepared, and we did not encounter any relaxation of the anchors, even in the oldest patient, who was 80 years old.

Even though three stab incisions were made for passage of the suture, there were neither scars nor dimples along the subciliary line. To pass the threads precisely through the pretarsal space along the subciliary line, as well as to take bites of the periosteum through a small incision along the periorbital line, we prefer to use small needles mounted originally on the device.

Akiteru Hayashi, M.D.

Department of Plastic and Reconstructive Surgery, Toho University Sakura Hospital, Chiba, Japan

Yu Maruyama, M.D.

Department of Plastic and Reconstructive Surgery, Toho University Hospital, Tokyo, Japan


1. Hayashi, A., Maruyama, Y., Okada, E., and Ogino, A. Use of a suture anchor for correction of ectropion in facial paralysis. Plast. Reconstr. Surg. 115: 234, 2005.
2. Antonyshyn, O. M., Weinberg, M. J., and Dagum, A. B. Use of a new anchoring device for tendon reinsertion in medial canthopexy. Plast. Reconstr. Surg. 98: 520, 1996.
3. Dzwierzynski, W. W., Sanger, J. R., and Larson, D. L. Use of Mitek suture anchors in head and neck reconstruction. Ann. Plast. Surg. 38: 449, 1997.
4. Seeley, B. M., To, W. C., and Papay, F. A. A multivectored bone-anchored system for facial resuspension in patients with facial paralysis. Plast. Reconstr. Surg. 108: 1686, 2001.

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