Paralytic lagophthalmos correction using а hard palate graft

Relevance Spacers are widely used to correct paralytic lagophthalmos (PL). Progressive ptosis of the midface reduces the effectiveness of PL correction, which necessitates the improvement of traditional surgical techniques [1–5]. Objective To evaluate the capabilities of a new technique for PL correction using a hard palate graft. Material and methods The patient had preoperative OD: MLD2 = 2 mm, lagophthalmos 4 mm, keratopathy in the lower 1/3. When collecting the graft from the hard palate, lateral incisions were made from the mucosa to the periosteum at an obtuse angle in the outward direction. A raspatory and a monopolar electrode with a curved tip were mainly used. The presence of the periosteum was verified endoscopically with angular optics. A bed was formed, the size of the graft was modeled, and it was sutured to the edges of the bed and the lower leg of the outer canthus under the control of an operating microscope. Results After 6 months, the eyelid position is correct, lagophthalmos 0.5 mm. The cornea is transparent. Conclusion The effectiveness is due to the improvement of the frame properties, precise modeling of the transplant size, and more reliable fixation [3]. Keywords: facial paralysis; lagophthalmos; spacer; transplant from the hard palate