LONG-TERM RESULTS AFTER PRETARSAL FIXATION OF GOLD WEIGHTS IN FACIAL NERVE PALSY

  • A. MIHAI “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • V. PIEPTU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Mihaela TIMOFTE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • D. PIEPTU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
Keywords: FACIAL PALSY, CORNEAL EXPOSURE, GOLD WEIGHTS

Abstract

Chronic corneal exposure after facial palsy is a clinically condition requiring immediate treatment. The most effective and simple solution is the gold weight implant into the upper eyelid. Aim: to evaluate our long-term results using this method. Materials and methods: This is a retrospective study of the outcomes after pretarsal placement of gold weights in 20 patients operated by one surgeon from 2002 to 2020. Results: A total of 20 patients were included in the study. Follow up period ranged from 5 to 21 years. None of them have postoperative infections, ptosis, keratopathy, nor have they reduced visual acuity. Fifteen out of twenty patients have the implant in an adequate position, with appropriate lid closure. Two patients developed minimal implant migration and slight asymmetry, but implant remained functional and in place. Three patients developed important implant migration leading to extrusion. Conclusions: The results of our long-term study are similar to those revealed in the literature. Considering the favorable post-operative outcomes, we would recommend this technique for using either as a self-standing procedure or in conjunction with other static or dynamic procedures in facial palsy. For long term results and for improved migration and implant extrusion rates we recommend under correction by choosing to place the lighter implant instead of the “perfect”, heavier implant.

Author Biographies

V. PIEPTU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Regional Institute of Oncology Iasi
Plastic Surgery Unit

Mihaela TIMOFTE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Regional Institute of Oncology Iasi
Plastic Surgery Unit

D. PIEPTU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Regional Institute of Oncology Iasi
Plastic Surgery Unit

References

1. Pereira MV, Glória AL. Lagophthalmos. Semin Ophthalmol 2010; 25(3): 72-78 / doi: 10.3109/ 0882 0538.2010.488578.
2. Sheehan JE. Progress in correction of facial palsy with tantalum wire and mesh. Surgery 1950; 27(1): 122-125.
3. Illig KM. Eine neue Operationsmethode gegen Lagophthalmus [A new method of lagophthalmos surgery]. Klin Monbl Augenheilkd Augenarztl Fortbild 1958; 132(3): 410-411.
4. Smellie GD. Restoration of the blinking reflex in facial palsy by a simple lid-load operation. Br J Plast Surg 1966; 19(3): 279-283 / doi: 10.1016/S0007-1226(66)80056-5.
5. Mancini R, Taban M, Lowinger A, et al. Use of hyaluronic Acid gel in the management of paralytic lagophthalmos: the hyaluronic Acid gel “gold weight”. Ophthalmic Plast Reconstr Surg 2009; 25(1): 23-26 / doi:10.1097/IOP.0b013e318192568d P.
6. Harrisberg BP, Singh RP, Croxson GR, et al. Long-term outcome of gold eyelid weights in patients with facial nerve palsy. Otol Neurotol 2001; 22(3): 397-400 / doi:10.1097/ 00129 492-200105000-00022.
7. Schrom T, Wernecke K, Thelen A, et al. Ergebnisse nach Lidgewichtimplantation mit starren Goldgewichten-eine Metaanalyse [Results after lidloading with rigid gold weights-a meta-analysis]. Laryngorhinootologie 2007; 86(2): 117-123 / doi:10.1055/s-2006-944748.
8. El Shazly M, Guindi S. Static management of lagophthalmos following facial nerve paralysis using standardized weights. Rev Laryngol Otol Rhinol (Bord) 2008; 129(4-5): 263-266.
9. Caesar RH, Friebel J, McNab AA. Upper lid loading with gold weights in paralytic lagophthalmos: a modified technique to maximize the long-term functional and cosmetic success. Orbit 2004; 23(1): 27-32 / doi:10.1076/orbi.23.1.27.28994.
10. Akcal A, Savas SA, Ozkan O, et al. Treating the Golden Implant Visibility on a Paralytic Eye by Using the Capsule Shield Technique. J Craniofac Surg 2016; 27(1): 191-193 / doi:10.1097/ SCS. 00 00000000002269.
11. Berghaus A, Neumann K, Schrom T. The platinum chain: a new upper-lid implant for facial palsy. Arch Facial Plast Surg 2003; 5(2): 166-170 / doi:10.1001/archfaci.5.2.166.
12. Rofagha S, Seiff SR. Long-term results for the use of gold eyelid load weights in the management of facial paralysis. Plast Reconstr Surg 2010; 125(1): 142-149 / doi:10.1097/ PRS.0b013e3181c2a4f2.
13. Kelley SA, Sharpe DT. Gold eyelid weights in patients with facial palsy: a patient review. Plast Re-constr Surg 1992; 89(3): 436-440 / doi:10.1097/00006534-199203000-00006 .
14. Lessa S, Nanci M, Sebastiá R, et al. Treatment of paralytic lagophthalmos with gold weight implants covered by levator aponeurosis. Ophthalmic Plast Reconstr Surg 2009; 25(3): 189-193 / doi:10.1097 / IOP.0b013e3181a13d72
15. Kartush JM, Linstrom CJ, McCann PM, et al. Early gold weight eyelid implantation for facial paral-ysis. Otolaryngol Head Neck Surg 1990; 103(6): 1016-1023 / doi:10.1177/ 01945 99 89 010300622.
16. Nowak-Gospodarowicz I, Koktysz R, Rękas M. The impact of implantation site on procedure success in patients with unresolved facial palsy treated with upper-eyelid gold weight loading. Sci Rep 2022; 12(1): 11869 / doi:10.1038/s41598-022-16169-4.
Published
2024-04-03