Eye protection in the paralyzed face

All patients with a VIIth nerve paralysis with any limitation of closure of the eye should have in the office or out‐patient clinic setting: 1. paper tarsorrhaphy of the upper or possibly lower lid; 2. artificial tears and/or ointment; and 3. glasses to protect the cornea from air currents Kinetic and static surgical procedures are discussed. The kinetic procedures include facial nerve repair and grafting, VIIth‐XIIth nerve anastamosis, muscle nerve block transplantation, transposition of nonparalyzed muscle and cross over. The principals of VIIth nerve repair and grafting are presented in the intracranial, internal auditory canal, labyrinthine, tympanomastoid and extratemporal sites. The static procedures include resection of redundant skin, fascia lata strip suspension, weakening of contralateral non‐paralyzed musculature, and adjunctive procedures such as resection of ptotic melolabial fold, plication of parotid‐masseteric fascia, dermal graft suspension, blepharoplasty, brow lift, canthoplasty, horizontal shortening of lower lid, fascial suspension of lower lip, McLaughlin tarsorrhaphy, and palpebral spring. Patient counseling is emphasized.