Early gold weight lid implant for rehabilitation of faulty eyelid closure with facial paralysis: an alternative to tarsorrhaphy

Although tarsorrhaphy has been the mainstay of treatment for lagophthalmus associated with facial paralysis, it has many drawbacks which make it a less than ideal procedure. Gold weight implantation is a functionally and cosmetically superior alternative in many patients. Eighteen patients with both reversible and irreversible facial (eyelid) paralysis underwent early gold weight implantation for rehabilitation of faulty eyelid closure with satisfactory results. The advantages and disadvantages of this technique, when compared with other methods of correcting paralytic lagophthalmus, are discussed.     

Morbidity after gold weight insertion into the upper eyelid in facial palsy.

Morbidity and outcome after gold weight insertion into the upper eyelid in patients with lagophthalmos were assessed retrospectively by patient questionnaire and case-note review. Results indicated that although satisfaction with the lid and overall facial appearance was high, complications and symptoms attributable to the gold weights were not uncommon.     

Upper eyelid gold weight implants in patients with facial nerve palsy. Surgical technique

Facial nerve injuries produce lagophthalmos and consequent ocular disease caused by corneal exposure. The management of the affected eye in patients with facial palsy has been improved. Previously ointment, eye drops, taping, partial or complete tarsorrhaphy was the primary treatment of the inability to close the eyelid. Other mechanical techniques for reanimating lid closure, including palpebral springs, encircling the upper and lower eyelids with silicone or fascia lata, and temporalis muscle transfer. The most popular and widely used static procedure in facial nerve palsy is the upper eyelid gold weight implant. This procedure is the goal of the treatment for the restoration of function and cosmesis to the paralyzed eyelids. The surgical technique used for lid load insertion are described below.     

外伤性面瘫的早期手术治疗

目的回顾总结锐器切割伤导致面瘫的早期治疗效果。方法自2000年1月至2006年8月,治疗锐性面神经损伤患者5例。其中行Ⅰ期急诊手术者4例,根据面神经解剖表面标志,解剖并游离神经两端,在显微镜下端端吻合离断的面神经;行Ⅱ期手术者1例,在外伤后3个月内进行。结果术后随访患者5～8个月,5例患者均获得了比较满意的面肌功能恢复。结论早期采用面神经端端吻合术是治疗锐利性面神经损伤的关键。     

The use of gold weight in facial palsy lagophthalmos

Peripheral facial paralysis is often accompanied by incomplete closure of the lid. In the past, tarsorrhaphy has been the primary method for achieving improved eyelid closure, but it has functional and cosmetic drawbacks.As an alternative, a gold weight implant has been used for closure of the upper lid by gravity and, ifnecessary, can be combined with further rehabilitative facial surgery. A total of 36 patients with peripheral facial paresis were treated with gold weight upper lid implants. Postoperative closure of the lids was sufficient in all cases. Complications were observed, such as pseudoptosis, deficiency of eyelid closure, a prominent bulge of the gold implant, in one case frank extrusion of the gold implant, and, surprisingly, in several cases the formation of a low grade corneal astigmatism. The satisfactory functional results show that the implant is both aesthetically and functionally superior to tarsorrhaphy. Received: 4 March 1998 / Accepted: 25 May 1999     

Indications for labial reanimation in facial paralysis

The therapeutic approach of labial reanimation depends on several points, like the association with others abnormalities, the palsy which can be complete or partial, the age of the patient and the practice of the surgical team. Nevertheless, the authors try to propose a surgical approach of labial reanimation in facial palsy, depending on the facial nerve which can be reparable or not, and on the facial muscles which can be used or not. At least, the indications in partial labial palsy are recalled.     

Total facial nerve decompression for recurrent facial paralysis: an update

Recurrent facial paralysis (RFP) is a rare disorder that in some individuals may lead to worsening sequelae. Melkersson-Rosenthal syndrome is a variant of RFP that is associated with recurrent facial edema. In the past, decompression of the mastoid segment of the facial nerve has not been successful in preventing recurrences. In 1981 we began performing total facial nerve decompression for RFP and in 1986 reported its efficacy in one patient with Melkersson-Rosenthal syndrome and in another in whom both nerves were decompressed for alternating bilateral paralysis. An additional four cases with 3 to 8 years of followup demonstrate no recurrences in any patient. Total facial nerve decompression for RFP in selected patients appears efficacious in preventing recurrences. Decompression will remain investigational until further followup is obtained. Furthermore, its salutary effect should not be extrapolated to Bell's palsy without further study.     

Nerve repair and cable grafting for facial paralysis

Facial nerve injury and facial paralysis are devastating for patients. Although imperfect, primary repair is currently the best option to restore facial nerve function. Cable, or interposition, nerve grafting is an acceptable alternative when primary repair is not possible. Several donor nerves are at the surgeon's disposal. Great auricular, sural, or medial and lateral antebrachial cutaneous nerves are all easily obtained. Both primary repair and interposition grafting typically result in better facial function than do other dynamic and static rehabilitation strategies. Proficient anastomotic technique and, when necessary, selection of an appropriate interposition graft will optimize patient outcomes. Promising research is under way that will enhance future nerve repair and grafting efforts.