Vertical cross-face to correct dry eye in facial palsy patients

AIMS: Neurogenic dry eye following VII cranial nerve palsy could represent a major concern for patients, due to the requirement of lifelong treatment with artificial drops, higher incidence of conjunctivitis and the non-negligible risk of permanent corneal lesion. We developed a new treatment for neurogenic dry eye using a vertical cross face innervation from the submandibular gland and interpositional nerve graft. METHODS: 3 patients with dry eye following VII cranial nerve palsy underwent this new proposal of treatment. In all patients the ipsilateral submandibular gland innervation is identified via a traditional submandibular incision and the small parasympathetic fibres bundle is dissected from the gland. A small palpebral incision allows for superficial lacrimal gland surface isolation. A subcutaneous passage of a suralis nerve graft by a specific needle allows to connect and suturing the submandibular gland parasympathetic fibres to the lacrimal gland. The suralis nerve end is subdivided into its main fascicles and directly inserted into the lacrimal grand parenchyma. A pre and postoperative Schirner’s test allowed for quantifying the lacrimal secretion. Patients report about corneal lubrication is also recorded RESULTS: No patient reported complications after the procedure. Schirner’s test showed improvement of lacrimal secretion as soon as 6 months. Most notably all patients reported improvement of dry eye and reduction of the daily use of artificial tears. CONCLUSION: Preliminary results are encouraging: vertical cross face could represent an optional tool for treating neurogenic dry eye.