Gold weight and eyelid springs

Posted on   2009-04-21 09:04:46

Gold weight and eyelid springs, Ocular management

Ocular Management

The primary ocular signs of facial paralysis include inability to close the eyes completely, drooping of the lower eyelids, dryness or excessive tearing. Any failure to adequately address these issues can predispose the affected eye to corneal ulceration, keratitis, or irreversible loss of vision.

In all instances of complete facial paralysis or isolated impairment of eyelid closure, lubricating eye drops, artificial tears and other eye-protecting measures such as eyeglasses are imperative to minimize the risk of corneal ulceration. The use of antibiotic eyedrops such as chloramphenicol prior to sleep may also reduce the risk of infection in eyes with incomplete closure. Glasses or protective eyewear are mandatory particularly in the acute phase of the disease in order to prevent the entry of foreign particle into the affected eye until resolution of eyelid impairment. The use of a patch, a silk thread, gold weight implantations, and springs have been used effectively in the past to maintain eye closure in instances of eyelid impairment.

Depending on the extent of involvement and the severity of nerve deterioration, the management of eyelid paralysis in facial nerve disorders can involve medical therapy, surgical intervention, or both. Recent studies have suggested that as many as 94% of patients with incomplete paralysis associated with FNP will often recover spontaneously.

Surgical Management

Depending on the underlying etiology, a number of surgical options exist for correcting ocular impairments and hastening recovery in facial nerve palsy. The following is an overview of those surgical options with a particular emphasis placed upon their impact in addressing various clinical characteristics of paralysis of the face.

Gold weight placement

Given the fact that a number of patients with facial paralysis develop incomplete eye closure due to dysfunction of both the upper and lower eyelids, surgical intervention is often needed in order to improve ocular closure and minimize the risk of corneal damage. Implantation of a gold weight in the eyelid has been associated with long-term efficacy in meeting this objective in patients with Facial palsy. The most commonly used procedure involves incising the upper eyelid crease and cutting through the muscle in order to expose the area where the gold weight is anchored directly with sutures. Although gold weight placement maybe clinically beneficial, this procedure alone may be inadequate in some patients with facial paralysis. Thus, lower eyelid reconstruction is often needed in order to achieve maximal results and reduce long-term complications in patients receiving gold weight placement. The surgeons at the Facial Paralysis Institute habe begun to institute the use of Platinum chains which can provide even better outcome that gold weights.

Tarsorrhaphy

Tarsorrhaphy, which describes the sewing of the eyelids to reduce eyelid aperture, has been used infrequently as a result of poor cosmetic results and the compromised peripheral vision that often accompanies the procedure. Although uncommonly used, the benefits of this procedure lie in the fact that it can be reversed in the event of facial nerve function recovery.

Palpebral Spring

Eyelid springs are the only way to dynamically move the eyelids with a normal movement. Dr. Azizzadeh’s team has one of few surgeons in the world that have extensive experience in spring placement. The eyelid spring, also known as palpebral spring, places a specialized metal that allows the eye to naturally open and close the eyes despite total paralysis. Patients need to be selected carefully in order to obtain ideal results.

FACELIFT

NERVE TRANSPLANT- Cross Facial Nerve Graft

GRACILIS MUSCLE TRANSPLANT

STATIC SLING - SUSPENSION

HYPOGLOSSAL FACIAL NERVE TRANSFER

BOTOX

TEMPORALIS TRANSFER

ENDOSCOPIC BROWLIFT

EYELID RECONSTRUCTION

GOLD WEIGHT/EYELID SPRING