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Research Letter |

Transposed Corrugator Supercilii Muscle–Tendon Unit Flap for Contralateral Paralytic Medial Ectropion Repair

Dane J. Genther, MD1; Leslie R. Kim, MD, MPH1; Myriam D. Loyo, MD2; Kofi D. Boahene, MD1
[+] Author Affiliations
1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
JAMA Facial Plast Surg. 2016;18(3):231-232. doi:10.1001/jamafacial.2016.0019.
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This cadaver study assesses the feasibility of a transposed flap consisting of the corrugator supercilii muscle–tendon unit to repair a paralyzed medial ectropion.

In facial paralysis, denervation of the orbicularis oculi muscle (OOM) may result in loss of lower eyelid support and paralytic ectropion. Surgical repair of ectropion aims to reduce vertical palpebral aperture and reposition the eyelid and lacrimal punctum to the globe. Common ectropion repair techniques use static support of lower eyelid structures and include canthal tightening, eyelid shortening, and slings, which are not dynamic and are subject to relaxation and recurrence of eyelid laxity and malposition.1 Dynamic function can be restored only through reinnervation of the paralyzed OOM or transfer of functional muscle units, but, to our knowledge, few dynamic procedures have been described.2 In this preclinical study, we describe a novel technique for repair of paralytic medial ectropion using a flap consisting of the transposed contralateral corrugator supercilii muscle (CSM)–tendon unit. The contralateral CSM in unilateral facial paralysis remains innervated and may be transposed as a functional muscle unit.

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Cadaveric Dissection and Technique

A, The left corrugator supercilii muscle (CSM) is exposed after elevation of a laterally based skin flap. A hemostat is passed into the subciliary incision of the right lower eyelid and through a subperiosteal tunnel to the dissection cavity over the right CSM flap. B, The left CSM flap is transposed through the subperiosteal tunnel to the right medial lower eyelid and retracted under slight tension through the medial subciliary incision. C, The transposed right CSM flap is shown resting without tension, demonstrating adequate flap length for inset into the right medial lower eyelid.

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