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Functional and aesthetic outcomes of eyelid skin grafting in facial nerve palsy
  1. Sundas Ejaz Maqsood1,
  2. Nikhil Cascone1,
  3. Andre Grixti1,
  4. Ruben Kannan2,
  5. Charles Nduka2,
  6. Raman Malhotra1
  1. 1 Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
  2. 2 Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK
  1. Correspondence to Dr Sundas Ejaz Maqsood, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK; sundas.maqsood{at}


Aim To report the functional and aesthetic outcomes of eyelid full-thickness skin grafting (FTSG) in patients with facial nerve palsy (FNP).

Methods This is a retrospective, non-comparative, single-centre review of all patients with FNP who underwent FTSG over an 8-year period. Functional outcomes were collected through case notes review: CADS (cornea, static asymmetry and dynamic and synkinesis) score facial nerve grading and lagophthalmos on blink, gentle and forced closure. Marginal reflex distance (MRD1 and MRD2) was calculated on standardised photographs. The aesthetic outcomes were assessed objectively by two blinded independent assessors who assessed standardised photographs based on a mutually agreed grading scale. Both functional and aesthetic outcomes were measured preoperatively, and at early (1–3 months), intermediate (3–6 months) and late (>9 months) postoperative periods.

Results A total of 28 eyelid FTSGs were performed on 21 patients (11 female, 10 male) between 2008 and 2016. The mean age was 68 (range, 16–89) years and the mean follow-up was 20.8 (range, 12–30) months. The CADS score (cornea (p<0.001), static asymmetry (p<0.001), dynamic function (p<0.001)), MRD2 (p=0.002) and lagophthalmos (blink (p=0.003), gentle (p<0.001), forced (p=0.003)) improved through early and late postoperative periods. Aesthetically, the grafts appeared to look natural in terms of colour, surface contour and graft edge from the intermediate postoperative period and continued to improve significantly by the late postoperative period.

Conclusion The use of periocular FTSG is effective in improving lagophthalmos and periorbital symmetry in patients with FNP where skin contraction exists. They should be considered as an adjunct to other oculoplastic procedures for both functional and aesthetic rehabilitation.

  • cosmesis
  • eye lids
  • ocular surface

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  • Contributors Conception or design of the work: RM, SEM, NC, RK, CN. Data collection: SEM, NC, AG, RM. Data analysis and interpretation: SEM, NC, RK, RM. Drafting the article: SEM, RM, RK, CN. Critical revision of the article: SEM, RM, NC, AG, RK, CN. Final approval of the version to be published: SEM, RM, NC, AG, RK, CN.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the local institutional review board (Queen Victoria Hospital, East Grinstead, UK) as a retrospective audit.

  • Provenance and peer review Not commissioned; externally peer reviewed.