1. 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

2. 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:E Acta Otolaryngol Suppl. 2002;549:4-30
Incidences of idiopathic facial nerve palsy: persons per 100,000 per year
Ann Neurol. 1986;20: Acta Otolaryngol Suppl. 2002;549:4-30

3. Lagophthalmos

4. 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: 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

5. Treatment
Conservative treatment: patient compliance
-obscure vision

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

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

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

9. 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

10. 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

11. Result

12. Video

15. 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

16. 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:
-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: JAMA Facial Plast Surg 2014;16:335-42

17. 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

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

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

20. 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