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Chirurgische Korrektur des paralytischen Lagophthalmus

Surgical treatment of paralytic lagophthalmos

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Zusammenfassung

Eine Schädigung der Nervenfasern des Nervus facialis oder seines Kerngebiets führt zu einer ipsilateralen peripheren Fazialisparese und ist in Westeuropa und den USA mit einer Inzidenz von 20 bis 35 pro 100.000 Einwohner im Jahr ein häufiges Symptom. Als mögliche Komplikation einer Fazialisparese kann ein paralytischer Lagophthalmus auftreten, welcher neben der ästhetischen vor allem funktionelle Einschränkungen für den Patienten mit sich bringt.

Bei der Rehabilitation kommen neben der primären Nervenrekonstruktion plastisch-rekonstruktiven Verfahren zur Korrektur des paralytischen Lagophthalmus wichtige Aufgaben zu. Augenbraue, das Ober- und Unterlid, der mediale und laterale Lidwinkel sowie die abführenden Tränenwege müssen als funktionelle Einheiten betrachtet werden und können durch lokal-chirurgische Verfahren korrigiert werden. Als oberster Grundsatz gilt, dafür Sorge zu tragen, den Lidschluss sicherzustellen. Aufgrund der erheblichen ästhetischen Beeinträchtigung und der damit verbundenen psychischen Belastung sind allerdings auch kosmetische Aspekte in das chirurgische Konzept einzubeziehen.

Abstract

Impairment of the peripheral or central part of the facial nerve causes an ipsilateral peripheral facial nerve paresis. It is quite a common syndrome and affects 20–35 persons per 100,000 per year in Western Europe and the United States. A possible complication of facial palsy is paralytic lagophthalmos with aesthetic and functional impairment for the patient. Beside primary nerve reconstructive procedures plastic-reconstructive procedures play a major role in correcting paralytic lagophthalmos. The eyebrow, upper and lower lids, medial and lateral lid angle as well as the lacrimal system need to be seen as functional units and can be corrected with local surgical procedures. Restoration of eye closure is the most important goal in treating the affected eye. Due to the significant aesthetic limitations and resultant psychological stress for the patient cosmetic aspects must be included in the surgical concept.

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  1. Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, HELIOS Klinikum Bad Saarow, Pieskower Str. 33, 15526, Bad Saarow, Deutschland

    T. Schrom & F. Bast

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Correspondence to T. Schrom.

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Schrom, T., Bast, F. Chirurgische Korrektur des paralytischen Lagophthalmus. HNO 58, 279–291 (2010). https://doi.org/10.1007/s00106-009-2063-4

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