To describe the results of dynamic muscle transfer with an orbicularis oculi muscle flap from the contralateral side to the paralysed side in patients with House-Brackman grade 6 facial nerve palsy.

A case series of 6 patients who underwent dynamic muscle transfer with a flap of healthy orbicularis oculi muscle fibres from the contralateral side into into the paralysed orbicularis oculi muscle. All patients had a House-Brackman grade 6 facial nerve palsy. All the subjects had previous multiple surgical procedures to improve the eyelid function. In
spite of this they were all symptomatic in terms of corneal exposure before orbicularis muscle transfer. All patients had post-operative follow up in excess of 6 months after the procedure.

Results: All patients improved symptomatically and had clinically reduced lagophthalmos post-operatively.Five patients who had an absent blink reflex showed a significant
improvement in their blink reflex post-operatively. There were no complications at the donor site.

All patients showed a significant improvement of their symptoms and their lagophthalmos
reduced post-operatively. Most importantly, the blink occurred involuntarily at the same time as the blink on the normal side. The authors propose that a dynamic muscle transfer using the contralateral orbicularis muscle may be considered to improve lid closure and blink reflex to improve corneal exposure in patients with grade 6 facial palsy who have not benefited from conventional surgical procedures.