[Long-term results of two temporalis muscle transfer procedures in correction of paralytic lagophthalmos].

OBJECTIVE: To compare the long-term results and possible complications of a modified temporalis muscle transfer (TMT) with the Johnson's procedure in correction of paralytic lagophthalmos.

METHODS: From September 1997 to March 2000, paralytic lagophthalmos due to leprosy in 92 patients were corrected with TMT. The 89 cases (127 to eyes including 51 unilateral and 38 bilateral) followed up 3 years after operation were analyzed. There were 69 males and 20 females with ages ranging from 18 to 65 years (52 years on average). The duration of lagophthalmos was 1-22 years with an average of 8.2 years. And 36 eyes were complicated with lower eyelid ectropion. Sixty-five eyes were corrected with Johnson's procedure (Johnson's TMT group), 62 with the modified TMT procedure (modified TMT group). The modifications were as follows: (1) omitting the fascial strip in the lower eyelid to avoid postoperative ectropion. (2) fixing the fascial strip of the upper eyelid to the middle or inner margin of the tarsal palate depending on the degree of the lagophthalmos to avoid possible ptosis of the upper eyelid.

RESULTS: In Johnson's TMT group, the mean lid gap on light closure was reduced to 3.1 mm postoperatively from 7.7 mm preoperatively; and the mean lid gap on tight closure was reduced to 0.5 mm postoperatively from 6.1 mm preoperatively. The symptoms of redness (73.7%) and tearing (63.7%) disappeared or were improved postoperatively. However, ectropion and ptosis occurred in 24 eyes and 9 eyes respectively. The overall excellent and good rate was 58.5%. In the modified TMT group, the mean lid gap on light closure was reduced to 3.3 mm postoperatively from 7.5 mm preoperatively; and the mean lid gap on tight closure was reduced to 0. 6 mm postoperatively from 6. 3 mm preoperatively. The symptoms of redness (90.9%) and tearing (71.0%) disappeared or were improved postoperatively, and no ectropion or ptosis was found except one ectropion. The overall excellent and good rate was 87.1%, which was significantly higher than that of Johnson's group (P < 0.01).

CONCLUSION: The modified TMT is an efficiency and simple procedure with very few complications, and thus is strongly recommended for use when TMT is an indication.