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Facial Plast Surg
DOI: 10.1055/a-2272-6077
Original Article

Corneal Neurotization: Essentials for The Facial Paralysis Surgeon

Jordan R. Crabtree
1   Indiana University School of Medicine, Indianapolis, Indiana
,
Chilando Mulenga
1   Indiana University School of Medicine, Indianapolis, Indiana
,
Khoa Tran
2   Department of Surgery, Indiana University School of Medicine, Indiana
,
Arif Hussain
2   Department of Surgery, Indiana University School of Medicine, Indiana
,
Charline S. Boente
3   Department of Ophthalmology, Indiana University School of Medicine, Indiana
,
Asim Ali
4   Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Canada
,
Konstantin Feinberg
2   Department of Surgery, Indiana University School of Medicine, Indiana
,
Gregory H. Borschel 
1   Indiana University School of Medicine, Indianapolis, Indiana
2   Department of Surgery, Indiana University School of Medicine, Indiana
3   Department of Ophthalmology, Indiana University School of Medicine, Indiana
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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


Publication History

Accepted Manuscript online:
20 February 2024

Article published online:
18 March 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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