Modified Temporalis Muscle Flap for Eyelid Reanimation

Abstract

The reanimation of both upper and lower paralytic eyelids requires dynamic procedures for longevity of correction. Temporalis muscle ensures the criteria for reanimation and is used widely as a result. Many modifications were described to improve the success of the classical technique. One of these modifications was reported by the senior author in 1999. Twice as much muscle mass (in thickness) to the upper eyelid than the lower was taken and passed submuscularly 5 to 6 mm away from the limbus and a thinner split was passed subcutaneously beneath the lower cilia. The aim of this study was to present the outcomes of the technique after 38 operations with 37 patients and to describe deep temporalis musculofascial-fatty flap to recover depression of temporalis muscle split donor area. Seventeen lower eyelids were evaluated as mild, 12 were as moderate, and 9 were as severe ectropion. One upper eyelid was evaluated as mild, 14 were as moderate, and 23 were as severe lagophthalmos preoperatively. Mean follow-up time was 28.8 months. Five patients had mild ectropion and 2 patients had mild lagophthalmos postoperatively at last follow-up. Two patients needed medial canthal tendon reinsertion secondary to relaxation of fixation suture at medial canthus. All patients tolerated the procedure and all complaints were resolved without creating a notable cosmetic deformity.