Blink restoration in adult facial paralysis

Background: Impaired eyelid function in facial paralysis patients is a serious disability that can even threaten vision. Eye reanimation techniques and specifically blink restoration reinstates the cornea's protective mechanism and recovers a more natural appearance and eye function. Both dynamic and static procedures have been used to augment eye closure, but only dynamic procedures can lead to blink restoration. In this study, the experience of a single surgeon (J.K.T.) with dynamic procedures addressing the challenge of blink restoration is presented. Methods: A retrospective review of 95 adult patients who underwent dynamic procedures for blink restoration was performed. The patients were divided into two groups. Group A (n = 75) included patients who underwent nerve transfers, including cross-facial nerve grafting and subsequent microcoaptations, mini-hypoglossal nerve transfers, and direct orbicularis oculi muscle neurotization. Group B (n = 20) included patients who underwent eye sphincter substitution procedures, including pedicled frontalis or mini-temporalis transfers, free platysma, occipitalis, gracilis subunits, extensor digitorum brevis, and a slip of adductor longus transfer. Objective blink ratios were measured according to a protocol established by the senior author (J.K.T.). Results: The patients included 34 men and 61 women. Mean age was 34.9 ± 9.8 years. Denervation time ranged from 7 months to 42.12 years, and the mean denervation time was 13.02 years. Blink improvement was noted in all of the patients. Blink scores and ratios were consistently better in group A than in group B. Conclusion: Dynamic procedures provide the functional substrate on which subsequent static procedures can be performed and aid blink return