Lower eyelid procedures
The decision to treat or not mainly will depend on lower lid laxity, which is assessed by the snap test. Medial lower lid laxity can cause the inferior punctum to evert from the globe and result in epiphora. Correction is with a medial can- thoplasty. For excess lateral lower lid laxity, producing scleral show or ectropion, a horizontal lid-shortening procedure is indicated .
Regardless of cause, primary nerve anastomosis, in the acute setting, is the technique of choice for repair of a completely disrupted facial nerve. The repair should occur as early as possible, with up to 72 h post-injury. Regardless of technique chosen, tension-free repair is essential to prevent scarring and fibrosis .
A. Extratemporal neurorrhaphy
The optimal timing of primary neurorrhaphy is immediately following injury to permit coaptation of the nerve ends before scarring and retraction begins. The repair may be completed with either a perineural or epineural repair. Direct end-to-end anastomosis of the proximal and distal ends of a transected facial nerve provides the best chance for return of nerve function with either a 9-0 or 10-0 nylon suture .