Mucoperiosteal graft in the correction of paralytic lagophthalmos

Various spacers are used to achieve a higher position for the lower eyelid and reduce the degree of lagophthalmos in chronic facial palsy (CFP). Most authors consider a hard palate mucoperiosteal graft (HPG) to have major advantages over other spacers, particularly minimal shrinkage in the postoperative period. However, only a few publications report possible HPG shrinkage, and their findings are based on subjective assessments. Objective. The study aimed to perform clinical and echographic assessment of the lower eyelid tissues after the use of HPG for the correction of paralytic lagophthalmos (PL). Material and methods. The study included 30 patients (30 eyelids) with CFP and PL. The work involved measurement of biometric parameters of the palpebral fissure and ultrasound examination of the lower eyelid (high-resolution grayscale B-scan ultrasonography, color Doppler mapping with 3D mode, echodensitometry, and ultrasound biomicroscopy) at 6 and 12 months after HPG placement. Results. We observed significant changes in palpebral fissure parameters and improvement in the state of the cornea. The distance from the corneal light reflex to the lower eyelid margin (MRD2) decreased from 7.0±1.2 to 5.7±0.8 mm (p<0.001) after surgery, and the degree of lagophthalmos decreased from 2.75 [0.5; 6.0] to 1.0 [0.0; 3.0] mm (p<0.001). At 6 and 12 months, HPG thickness changed from 2.89±0.65 to 2.82±0.69 mm (p=0.68), height from 6.01±0.47 to 5.84±0.54 mm (p=0.449), and volume from 0.56±0.05 to 0.52±0.74 cm³ (p=0.398); these changes were not statistically significant. We identified features of HPG vascularization up to 12 months after HPG placement. The study also describes the complications of HPG placement. Conclusion. The use of HPG for the correction of PL showed high effectiveness and safety. There was no graft shrinkage during the 12-month follow-up period. The study demonstrates the capabilities of ultrasound methods for assessing the dimensions and biointegration features of HPG.