Corneal Neurotization by Ipsilateral Great Auricular Nerve Transfer and Circumferential Corneal Scleral Tunnel Incisions for Neurotrophic Keratopathy
Nate Jowett, MD; Roberto Pineda II, MD
Harvard Medical School, Boston, MA
Combined ipsilateral facial palsy and corneal anesthesia may lead to rapid corneal blindness. Corneal neurotization by transfer of contralateral supraorbital or supratrochlear nerves has proven effective for management of neurotrophic keratopathy. Herein, a novel approach to corneal neurotization by ipsilateral great auricular nerve transfer is described with initial clinical outcomes.
The degree of mobilization of great auricular nerve branches towards the inferior eyelid was assessed in cadavers. Two patients with combined unilateral Vth and VIIth cranial nerve deficits underwent ipsilateral great auricular nerve transfer to the insensate cornea using a sural nerve interposition graft. Fascicles were positioned within the peripheral cornea using circumferential corneal scleral tunnel incisions. Outcomes comprised visual acuity, corneal sensation and synesthesia, donor deficit, and degree of neurotization as assessed by corneal confocal microscopy.
At three months, improvements in visual acuity were noted, together with referred cold sensation with eye drop use and referred foreign body sensation that resolved with corneal irrigation. Donor deficit comprised loss of earlobe sensation alone. Confocal microscopy indicated improved corneal nerve density.
The ipisilateral great auricular nerve is a suitable option for corneal neurotization. Circumferential corneal scleral tunnel incisions permit for rapid neurotization of the neurotrophic cornea.
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