Restoration of Upper Eyelid Reanimation with Free Platysma Graft: Final Stage of Facial Reanimation After Gunshot Wound to Face

Abstract

Objective: Patients with gunshot wound (GSW) to the face will have massive soft tissue and bony damage from projectile and blast injury. They often will need multiple, staged reconstructive surgeries including restoration of the bony framework, facial reanimation with cross-facial nerve grafting, and free muscle flap for re-establishment of facial expression. Injury to or total loss of the facial nerve and branches can result in loss of function of the orbicularis oculi muscle, which leads to the loss of protective mechanisms of eyelid function and blink reflex. The purpose of the current paper with to provide a literature review and discussion of eyelid reanimation after facial paralysis and to discuss our surgical technique to staged blink reconstruction with free platysma muscle grafts of upper and lower eyelid. Methods: The patient is a 45-year-old male with a history of GSW to the right face. He underwent multiple reconstructive surgeries in the past including stabilization with soft tissue reconstruction, right mandibular reconstruction, right sided facial reanimation with cross-facial nerve graft and gracilis flap. In preparation for eyelid reanimation, he underwent cross-facial nerve graft from left temporal branch to right upper eyelid and right lower eyelid Results: At initial postoperative evaluation and removal of the Frost stitch, the patient had the ability to close his right eye with minimal lagophthalmos. Upon continued follow-up and after surgical swelling decreased, he had continued improvement of spontaneous blinking of the right eyelid with 1-2mm of lagophthalmos. At the 3-month follow-up he exhibited stronger blinking reflex and no symptoms of dry eye or further irritation. Conclusion: The presented case demonstrates that a free platysma graft with direct neurotization with cross-facial nerve graft fascicles can be utilized for restoration of spontaneous upper and lower eyelid animation. Furthermore, restoring upper eyelid reanimation with a free platysma graft has several shortcomings. Primarily, there may be failure of neurotization and inability of the spontaneous blink reflex to be present. Despite these limitations, we still recommend the utilization of free platysma graft to provide upper eyelid reanimation through cross-facial nerve grafting. Corresponding Author: Kongkrit Chaiyasate, 3555 W 13 Mile Rd #120, Royal Oak, MI, 48073, [email protected], 248-890-2515