Surgical correction of ptosis of the eyebrow.

In recent years there has been a reappraisal of the surgical principles concerned in the management of the ophthalmic complications of facial nerve paralysis. This is especially mirrored in the utilization of the palpebral spring (Morel-Fatio and Lalardrie, I967) and of silicone cerclage (Arion, I972) in an attempt to produce dynamic restoration of lid function. A more vigorous approach is also advocated to correct the eyebrow defect when this occurs in facial palsy. Ptosis of the eyebrow is an uncommon but disabling condition generally representative of severe damage to the facial nerve. Such injury has been observed subsequent to unavoidable trauma in the surgery of acoustic nerve neuroma. The infrequency of this condition in facial paralysis probably correlates with the specialized innervation of the upper face. Characteristically the affected brow droops excessively so that the hair line is much lower than its fellow. The ptotic element is most conspicuous in the temporal half of the eyebrow, and can be so manifest as to obscure vision and cause marked encroachment on the visual field (Fig. i). The disfiguring situation is readily rectified by plastic surgery restoring vision and producing a cosmetically acceptable appearance.