義大醫院耳鼻喉部 連景峯 王誌群 楊顓謙 許惇彦 施佑蓁 黃澤人 醫師 A Preliminary Report on the Application of a Real-Time Magnetic Device to Temporary Management of Paralytic Lagophthalmos 即時磁力裝置暫時應用於眼瞼閉合不全治療成果的初報 義大醫院耳鼻喉部 連景峯 王誌群 楊顓謙 許惇彦 施佑蓁 黃澤人 醫師

Introduction Causes of facial palsy: idiopathic (Bell’s palsy), traumatic (traffic accident, birth trauma), neoplastic (acoustic neuroma, head and neck cancer), infective (lyme disease, poliomyelitis), immunologic (multiple sclerosis), congenital, and miscellaneous, of which Bell’s palsy is most common Laryngoscope. 2014;124:E283-93 Acta Otolaryngol Suppl. 2002;549:4-30 Incidences of idiopathic facial nerve palsy: 25-32 persons per 100,000 per year Ann Neurol. 1986;20:622-7 Acta Otolaryngol Suppl. 2002;549:4-30

Lagophthalmos

Ophthal Plast Reconstr Surg. 2006;22:331-4 Bell’s palsy: -best prognosis of all peripheral facial nerve palsies -complete recovery 70-90% N Engl J Med 2007;357:1598-607 Acta Otolaryngol Suppl. 2002;549:4-30 Paralytic lagophthalmos may cause exposure keratitis, corneal abrasion, and blindness Ophthal Plast Reconstr Surg. 2006;22:331-4

Treatment Conservative treatment: -patient compliance -obscure vision

-most common long-term treatment Lid loading: -most common long-term treatment -complications: astigmatism, deterioration of visual acuity, foreign body sensation— Laryngoscope. 1997;107:1617-22 Clin Otolaryngol Allied Sci 2004;29:279-83 Otolaryngol Head Neck Surg. 2009;140:82-5

Tarsorrhaphy techniques: simple and reversible -visual field deficits, aesthetic drawbacks -performed after failure of lid weighting Plast Reconstr Surg 2009;123:1697-703

Purpose A prototype real-time magnetic wearing device designed to provide an optional treatment for paralytic lagophthalmos (application)

Method Participants: case 1: 60 y/o, parotid carcinoma s/p total parotidectomy, MRND case 2: 56 y/o, upper gingival ca s/p System diagram

Test the application of the prototype including Efficacy -synchronized blinks -complete closure Safety -blurred vision, eyeball foreign body sensation, skin burning or hot sensation, eyelid erythema or pruritus

Result

Video

Completely close the affected eye, synchronized with the contralateral healthy side Subjective sensation and complications   Blurred vision Eyeball foreign body sensation Skin burning or hot sensation Eyelid erythema or pruritus Case 1 none Case 2 mild hot sensation

Discussion Blink detection implemented by -camera and image processing 95% TP Journal of Network and Computer Applications 2002;25:129-43  International Journal of Computer Science and Information Technology 2015; 6,4965-8 -infrared receiver and transmitter TP 87% JAMA Facial Plast Surg 2014;16:211–8 Sensors And Actuators A: Physical 2008;148:388-394 -myoelectric signal of orbicularis oculi m. 90% accuracy IEEE transactions on biomedical circuits and systems 2013;7:140-8 Otolaryngol Head Neck Surg 2013;148:209-14 JAMA Facial Plast Surg 2014;16:335-42

Mean detection rate in the present study was 94 Mean detection rate in the present study was 94.2 (8 normal volunteers) -acceptable results true positive 87% JAMA Facial Plast Surg 2014;16:211–8 -higher rates by delicately adjusting the position and alignment

Otolaryngology-Head and Neck Surgery 2012;146:230-3

Qualified efficacy & safety: achievable in 2 patients applicable treatment modality First real-time magnetic design to be successfully presented

Conclusion The real-time magnetic device may synchronously and symmetrically assist in closing eye without discomfort and complication  temporary nonsurgical management for paralytic lagophthalmos Subjective sensation and complications should be further confirmed by a large number of cases with long-term use