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Research Letter
December 20, 2018

The Bipedicled Orbicularis Oculi Myocutaneous Flap for the Repair of Paralytic Ectropion

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill
  • 2Otolaryngology–Head and Neck Service, WakeMed Hospitals, Raleigh, North Carolina
JAMA Facial Plast Surg. Published online December 20, 2018. doi:10.1001/jamafacial.2018.1704

Paralytic eyelid syndrome results from the global loss of neuronal input to periocular and facial musculature. Loss of innervation to the orbicularis oculi muscle, the primary eyelid protractor, allows for unopposed eyelid retractor action. Gravitational inferior displacement of atonic midfacial muscles further stretches the retaining ligaments of the lower face. Over time, this syndrome can create an anterior lamellar deficiency, lacrimal pump failure, and exposure keratopathy.1-3 Surgical correction has traditionally been accomplished with eyelid shortening and repositioning, but recurrence of ectropion in paralytic eyelid syndrome remains high.4