Dynamic Eye Closure

In facial reanimation, functional problems around the eye demand priority treatment to avoid any harm to the patient’s vision. Compared to static ocular reanimation, dynamic concepts involve the creation of active eye closure via nerve and/or muscle transfer and usually apply to long-standing, irreversible facial palsy or congenital absence of the facial nerve or muscles. The temporalis muscle transposition is a straightforward, reliable approach in adults providing immediate function, but lacks responsiveness to emotion and spontaneous blinking reflex. Frontalis muscle transposition should be considered in young facial palsy patients with severe ocular involvement. In contrast to regional muscle transposition, free muscle transfer such as the gracilis muscle or platysma transfer requires a prolonged recovery time and microsurgical skills, but provides a high amplitude of movement, blink restoration, and potential simultaneous multi-level restoration of the completely paralyzed hemi face.