Corneal Neurotization: Essentials for The Facial Paralysis Surgeon

Jordan R. Crabtree; Chilando Mulenga; Khoa Tran; Arif Hussain; Charline S. Boente; Asim Ali; Konstantin Feinberg; Gregory H. Borschel

doi:10.1055/a-2272-6077

Facial Plastic Surgery, Table of Contents

Facial Plast Surg 2024; 40(04): 424-432
DOI: 10.1055/a-2272-6077

Original Article

Corneal Neurotization: Essentials for The Facial Paralysis Surgeon

Jordan R. Crabtree

¹Indiana University School of Medicine, Indianapolis, Indiana

,

Chilando Mulenga

¹Indiana University School of Medicine, Indianapolis, Indiana

,

Khoa Tran

²Department of Surgery, Indiana University School of Medicine, Indiana

,

Arif Hussain

²Department of Surgery, Indiana University School of Medicine, Indiana

,

Charline S. Boente

³Department of Ophthalmology, Indiana University School of Medicine, Indiana

,

Asim Ali

⁴Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Canada

,

Konstantin Feinberg

²Department of Surgery, Indiana University School of Medicine, Indiana

,

Gregory H. Borschel

¹Indiana University School of Medicine, Indianapolis, Indiana

²Department of Surgery, Indiana University School of Medicine, Indiana

³Department of Ophthalmology, Indiana University School of Medicine, Indiana

› Author Affiliations

Abstract

Deficits in corneal innervation lead to neurotrophic keratopathy (NK). NK is frequently associated with facial palsy, and corneal damage can be accelerated by facial palsy deficits. Corneal nerves are important regulators of limbal stem cells, which play a critical role in epithelial maintenance and healing. Nonsurgical treatments of NK have undergone recent innovation, and growth factors implicated in corneal epithelial renewal are a promising therapeutic avenue. However, surgical intervention with corneal neurotization (CN) remains the only definitive treatment of NK. CN involves the transfer of unaffected sensory donor nerve branches to the affected cornea, and a variety of donor nerves and approaches have been described. CN can be performed in a direct or indirect manner; employ the supraorbital, supratrochlear, infraorbital, or great auricular nerves; and utilize autograft, allograft, or nerve transfer alone. Unfortunately, comparative studies of these factors are limited due to the procedure's novelty and varied recovery timelines after CN. Regardless of the chosen approach, CN has been shown to be a safe and effective procedure to restore corneal sensation and improve visual acuity in patients with NK.

Keywords

neurotrophic keratopathy - corneal neurotization - corneal sensation - anesthetic cornea - corneal nerve

Full Text

References

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