Surgical Correction of Paralytic Lagophthalmos
施政坪(Zheng-Ping Shi)；高全祥(Chuan-Hsiang Kao)；王興萬(Hsing-Won Wang)
金片 ； 眼閉合不全 ； gold weight ； lagophthalmos
|Volume or Term/Year and Month of Publication||
40卷1期（2005 / 01 / 01）
38 - 41
顏面神經麻痺會造成一側臉部肌肉無力，導致兩側臉部不對稱，其致病原因主要有貝爾氏麻痺(Bell's palsy)、腫瘤、感染、創傷、醫源性傷害及中樞疾病等。臉部肌肉嚴重無力時可造成患側眉毛、眼瞼、嘴角等下垂而影響顏面美觀，眼睛則因眼輪匝肌無力而無法完全閉合而形成眼閉合不全(lagophthalmos，俗稱兔眼症），可造成眼睛不適、刺激感、溢淚、視力減退，甚至失明。治療除改善顏面美觀外，預防眼部併發症亦相當的重要。本文報告一名80歲男性5年前因右側外耳道鱗狀上皮細胞癌接受過腫瘤切除術及放射線治療後，顏面神經因此嚴重麻痺並形成眼閉合不全。患者在接受金片(gold weight)植入右上眼瞼及其他輔助性手術後，病患眼睛得以完全閉合，眼睛不適症狀及視野均獲得明顯改善。
Facial paralysis causes loss of voluntary movement of one side of the face and hence asymmetry of the face. The common etiologies include Bell's palsy, tumor, infection, trauma, iatrogenic injury, and CNS disease. Facial paralysis disturbs the aesthetics due to brow and eyelid ptosis, drooping of the mouth angle, drooling and it also contributes to eye discomfort, ocular irritation, epiphora, visual disturbance, visual field defect and even results in blindness. Therefore, the purpose of management is essentially to prevent ocular symptoms in addition to correcting the aesthetic defects, especially for the patient with severe and permanent facial paralysis. We are reporting on an 80-year-old male who presented with severe facial paralysis of five years duration. He underwent a tumor resection followed by postoperative radiotherapy due to squamous cell carcinoma of the right external auditory canal. The ophthalmic sequelae of his facial paralysis included irritability, painful sensation, epiphora, lagophthalmos and ectropion. He underwent a gold weight implantation for correction of lagophthalmos, and subsequent ancillary procedures. Postoperatively, he could completely close the right eye and showed improvement of symmetry in both eyes, mouth angles and face. His visual acuity and speaking ability were improved.