We thank Dr. Bernardino for his thoughtful comments concerning our article published in the January 2005 issue of the Journal.1 Among the seven patients in our series, one patient developed a suture abscess in the medial region of the lower eyelid, but the 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, so the postoperative evaluation of this patient was based on the second procedure. There were no other complications related to permanent materials, including infection or exposure of sutures or anchors, in our series.
As indicated in our article, a single-stage neurovascularized muscle transfer was carried out simultaneously in case 1 and case 3. We suppose that neurotization occurred in these patients and that this contributed to some extent to recovery of the orbicularis oculi and frontalis as well as static tension of the right cheek. Actually, some recovery of the orbicularis oculi and support of the cheek by the transferred muscle might have partially contributed to resolution of the lagophthalmos. We do not agree that the lagophthalmos in these cases was merely “due to upper eyelid retraction.” We considered that the correction of ectropion variously contributed to resolution of the lagophthalmos in all of our patients. We would like to emphasize that our procedure is a good option for correcting ectropion as part of the complex management of facial paralysis, and that reliable results, including consistent suspension of the lower lid, were obtained in our patients. When contractile force or gravity continuously pulls the cheek region downward, our method for ectropion repair should not be used in isolation. In such situations, release of the contracture and correction of midfacial descent are necessary in addition to ectropion repair.2 If the lagophthalmos is due to upper eyelid retraction and remains vision-threatening, a gold weight is a good option to be considered.3
The cause of facial paralysis was Bell’s palsy in two patients, a 78-year-old woman and an 80-year-old woman, and the preoperative periods of complete paralysis were 4 years and 6 years, respectively. Therefore, we recognized these patients as having established facial paralysis and performed correction of ectropion using our simple, easy, and less invasive procedure.
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., and Maruyama, Y. Use of a suture anchor for correction of ectropion in facial paralysis. Plast. Reconstr. Surg.
115: 234, 2005.
2. McCord, C. D. The correction of lower lid malposition following lower lid blepharoplasty. Plast. Reconstr. Surg.
103: 1036, 1999.
3. Ueda, K., Harii, K., Yamada, A., and Asato, H. A comparison of temporal muscle transfer and lid loading in the treatment of paralytic lagophthalmos. Scand. J. Plast. Reconstr. Hand Surg.
29: 45, 1995.
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