Lagophthalmos from the neurosurgeon's point of view Prevention and treatment of trigeminal and facial nerves compromise

Lagophthalmos is a serious functional and cosmetic disorder in patients with facial nerve palsies. It is even more difficult and urgent to treat in additional trigeminal lesions. In a series of 1000 acoustic nerve tumors, 250 cerebellopontine angle meningiomas and 200 other cerebellopontine angle tumors, many hundreds of patients transferred from other institutions, 160 patients were treated neurosurgically and a further 80 by plastic surgery for facial nerve palsies. The indication of the type of treatment depends on (1) the knowledge of facial nerve continuity or discontinuity, (2) the duration since the onset of the palsy, (3) its completeness or signs of recovery, (4) the patient's individual tendency to atrophy and on his or her age. In case of definite nerve discontinuity, immediate nerve reconstruction by nerve transplantation is necessary and technically possible along the whole course of the facial nerve from the brainstem up to the region of the parotid gland. In 61 patients nerve transplantatio...