Eyelid reconstruction after facial paralysis

I had the pleasure of taking care of a young man who suffered a salivary gland cancer on the right side, requiring some surgery that led to right-sided facial paralysis.  He came to me after another physician had already placed a gold weight in the upper eyelid to help it close better.  This succeeded, although it was somewhat laterally displaced, causing a slight downturn at the outside corner of the eyelid.
 
The reason that this patient came to me was because the eye was read, tearing, and uncomfortable.  He could not drive in the bright sunlight without sunglasses because the eye was so sensitive.  As you can see below, the right lower eyelid is low, exposing much more of the eye on the right.  More of the sclera (white of the eye) is visible.  The eye itself is red on the right.  (Yellow dye has been placed to allow me to examine the surface of the eye more carefully).
 

 
In patients such as these, it is important to achieve a durable cure, because the paralysis at this point is irreversible.  The lower eyelid is paralyzed and needs vertical support.  An ear cartilage graft was chosen to provide this support, as it will last forever, is well-tolerated by the body, and has good rigidity.
 
The ear cartilage graft was taken in a way that leave no deformity in the ear, as can be seen from the intraoperative photo below:
 
 

At one month, one can see the significant improvement in the right lower eyelid. (There is a small amount of swelling that remains at this point.) The right upper eyelid and right brow were left alone — he may wish to adjust that gold weight or lift the right brow at a later date.  Most importantly, he has had a huge reduction in symptoms, his eye does not hurt, he can drive in sunlight without sunglasses, and he is preparing to carry on with his normal activities all summer long.

 

 

A pre/post collage is seen below:

 

 

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