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Rozenbroek P, Waugh A, Heller G, Hayler R, Cleary J, Hasmat S, Lovell NH, Suaning G, Clark JR, Low THH. Acceptance and willingness of patients with chronic facial nerve palsy for an implantable device that assists with eye closure. J Plast Reconstr Aesthet Surg 2024:S1748-6815(24)00583-7. [PMID: 39379217 DOI: 10.1016/j.bjps.2024.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/25/2024] [Accepted: 09/01/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND Patients with facial nerve palsy often experience lagophthalmos (incomplete eye closure), which can lead to exposure keratitis. The Bionic Lid Implant for Natural Eye Closure (BLINC) is a medical device designed to mimic the more natural blink kinetics than traditional lid loading techniques. AIMS This study aimed to evaluate potential factors that might influence the design of the BLINC device and willingness of participant to undergo the implant placement surgery. METHODS Patients attending a multidisciplinary facial nerve clinic were invited to complete a survey addressing patient acceptance of the BLINC device implantation. RESULTS Seventy-two patients were mailed the survey, of which 50 returned completed surveys (69%). The most important factor identified by participants was the device function (81% ranked as very important) and the least important factor was cost (16% ranked as very important). Median acceptable device function time was 5 years (range 1-10 years). Ten participants (20%) indicated willingness to be the first to trial BLINC. Women were more likely to rate visual appearance as important (OR 3.32, CI 1.14-9.62, p = 0.028), and less likely to rate user friendliness as important (OR 0.16, CI 0.04-0.52, p = 0.0021). Older participants were more likely to rate the length of recovery period as important (OR 1.04, CI 1.01-1.08, p = 0.006). Participants with complete eye closure were less likely to be willing to trial the implant (OR 0.08, CI 0.00-0.53, p = 0.006, whilst patients with eye irritation were more willing to trial the implant (OR 7.20, CI 1.12-142, p = 0.036). CONCLUSION Certain patient demographics impact patient aesthetic and functional preferences and the willingness to trial the BLINC device.
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Affiliation(s)
- Paul Rozenbroek
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia.
| | - Annie Waugh
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Gillian Heller
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Raymond Hayler
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia; Sydney Facial Nerve Clinic, The Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Jacinta Cleary
- Graduate School of Biomedical Engineering, Tyree Institute of Health Engineering (IHealthE) UNSW, Sydney, Australia
| | - Shaheen Hasmat
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia; Graduate School of Biomedical Engineering, Tyree Institute of Health Engineering (IHealthE) UNSW, Sydney, Australia
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, Tyree Institute of Health Engineering (IHealthE) UNSW, Sydney, Australia
| | - Gregg Suaning
- School of Biomedical Engineering, University of Sydney, Sydney, Australia; Freiburg Institute for Advanced Studies, Albert-Ludwigs-Universität, Freiburg, Germany
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia; Sydney Facial Nerve Clinic, The Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia; Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia
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Ozturan O, Yenigun A, Senturk E, Aksoy F. Sutureless transconjunctival insertion of eyelid gold weight. Am J Otolaryngol 2023; 44:103874. [PMID: 37011541 DOI: 10.1016/j.amjoto.2023.103874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Surgical intervention for paralytic lagophthalmos has been gold weight implant through supratarsal crease incision for decades. The aim of this study is to propose a modified novel minimally invasive approach that can be described as sutureless and transconjunctival placement of eyelid weights. METHOD Unilateral eyelid gold weights were implanted in six patients due to paralytic lagophthalmos secondary to peripheral facial nerve palsy. The patients were followed for an average of 6 months. RESULTS Functional and aesthetically desired results were obtained in all six patients with suture-free transconjunctival placement of the eyelid weight. The patients did not experience any discomfort and avoided the burden of suture removal after the surgery. No complications developed in six patients during the postoperative period. CONCLUSION Sutureless transconjunctival insertion of eyelid weight without external incision and suturing is practical, relatively easy and fast to perform. It preserves attachment of the levator muscle to the tarsus and presents functional results similar to conventional method. Fixing the implant with sutures to the tarsal plate is not needed. Sutureless of this method avoids external wound care, burden of suture removal for both surgeons and patients, and hence, suture related complications are eliminated.
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Affiliation(s)
- Orhan Ozturan
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Alper Yenigun
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey.
| | - Erol Senturk
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Fadlullah Aksoy
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
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Modified McLaughlin's Dynamic Muscle Support in the 21st Century? A Retrospective Study With a Prospective Follow-Up Analysis for Patients With Long Standing Facial Paralysis. J Craniofac Surg 2022; 33:e594-e598. [PMID: 35765144 DOI: 10.1097/scs.0000000000008668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/06/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Facial nerve paralysis can dramatically affect the life of a patient as it leads to significant alterations of the facial symmetry and functional limitations. Various methods exist including free neuromuscular flaps to reanimate patients suffering from uni- or even bilateral facial nerve paralysis. The more than 60-year-old technique described by McLaughlin continues to offer an alternative with distinct advantages for the individual patient. The present study aimed to evaluate clinical outcome and satisfaction of patients treated with a modified McLaughlin's Dynamic Muscle Support. MATERIALS AND METHODS A total of 13 patients (mean age of 58.4 years) who received a modified McLaughlin's Dynamic Muscle Support due to uni- or bilateral long-standing facial paralysis were included. Medical records were reviewed retrospectively, and patients were contacted for additional follow-up. Patients who agreed to participate in the follow-up study were asked to answer a self-developed questionnaire. RESULTS In all patients, a rehabilitation of facial symmetry with an improvement of the mimic expression could be achieved. Mean length of inpatient stay was 6.5 days and average duration of surgery was 121 minutes. No surgical site infection occurred. Mean follow-up was 23 months. Most of the patients were fully satisfied with the result and could experience functional and esthetic improvement.Patients who participated in the prospective follow-up study were very satisfied with the esthetic result and functional outcome. CONCLUSIONS Even in times of advanced microsurgical techniques, McLaughlin's Dynamic Muscle Support appears to be a good alternative for the successful treatment of long-standing facial paralysis.
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Elahi E, Afshin EE, Guthrie AJ, Lo C. Sutureless Transconjunctival Insertion of Eyelid Weights: A Novel Technique. Ophthalmic Plast Reconstr Surg 2022; 38:87-89. [PMID: 34750312 DOI: 10.1097/iop.0000000000002069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a novel surgical technique for implanting eyelid weights via a sutureless transconjunctival approach. In comparison to the traditional supratarsal crease approach, this technique does not involve any external incisions or suture placement. The procedure can reduce surgical time and complications associated with the traditional external approach. METHODS This case series includes 13 patients who underwent eyelid weight placement via the transconjunctival approach for paralytic lagophthalmos secondary to facial nerve paralysis (12 patients had unilateral paralysis and 1 patient had bilateral) with a total of 14 eyelid weights placed. The procedures were performed at an outpatient office-based surgical center. All procedures were performed or supervised by the same surgeon. Patients were followed for an average 6-month postoperative period for postoperative complications. RESULTS The sutureless transconjunctival approach to eyelid weight insertion was successful in achieving the desired functional and aesthetic outcomes. Patients undergoing this technique avoided the discomfort of postoperative suture removal. All patients achieved comparable outcomes postoperatively. There were no complications reported across the 13 patients throughout the 6-month postoperative period. CONCLUSIONS This case series demonstrates that the transconjunctival approach for metal eyelid weight insertion is practical, relatively easy to perform, and associated with functional outcomes that are comparable to those achieved with the traditional approach, however, without external incision or placement of sutures.
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Affiliation(s)
- Ebby Elahi
- Departments of Ophthalmology, Otolaryngology, Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Evan E Afshin
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, New York
| | - Ashley J Guthrie
- Guthrie Facial Plastic Surgery, Private Practice, Brentwood, Tennessee
| | - Christopher Lo
- Eyesthetica, Private Practice, Los Angeles, California, U.S.A
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Lipofilling of the upper eyelid to treat paralytic lagophthalmos. Br J Oral Maxillofac Surg 2020; 58:558-563. [PMID: 32145955 DOI: 10.1016/j.bjoms.2020.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/19/2020] [Indexed: 11/22/2022]
Abstract
Lagophthalmos is one of the most unpleasant and dangerous conditions that affect patients with facial palsy. The lack of ocular protection leads to corneal problems (such as conjunctival infections, acute and chronic keratitis, corneal ulcerations, and blindness). A dynamic reanimation of blinking eyelids is the therapeutic gold standard. However, success is not guaranteed with these dynamic techniques; even if results are good, blinking is usually restored within a year of the initial operation. Procedures that act more rapidly and have a higher success rate are needed. We proposed that lipofilling of the upper eyelid would improve eye closure, exploit the advantages of using autologous fat, and avoid the risks of exposure or migration associated with loading the lid with gold. Between 2012 and September 2018, we did upper eyelid lipofilling procedures for 75 patients with unilateral facial palsy. The main favourable result of lipofilling of the upper lid was the immediate improvement in corneal discomfort. Everybody described a partial to total increase in corneal comfort postoperatively. In the treatment of paralytic lagophthalmos, lipofilling of the upper eyelid produces favourable aesthetic and functional results, ocular health is restored, and the patients' quality of life is improved.
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Upper Eyelid Gold Weight Implantation for Facial Nerve Palsy—Short-Term and Long-Term Results. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1854-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Pausch NC, Kuhnt CP, Halama D. Upper-eyelid weight implants for patients with lagophthalmos—comparison of rigid and flexible implants. J Craniomaxillofac Surg 2018; 46:1843-1849. [DOI: 10.1016/j.jcms.2018.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/19/2018] [Indexed: 11/29/2022] Open
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Reanimation of the paralyzed lids by cross-face nerve graft and platysma transfer. J Craniomaxillofac Surg 2018; 46:521-526. [DOI: 10.1016/j.jcms.2017.12.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/27/2017] [Accepted: 12/18/2017] [Indexed: 11/23/2022] Open
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Restoration of eye closure in facial paralysis using implantable electromagnetic actuator. J Plast Reconstr Aesthet Surg 2016; 69:1521-1525. [DOI: 10.1016/j.bjps.2016.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/08/2016] [Accepted: 08/22/2016] [Indexed: 11/21/2022]
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Nerobeev AI, Shurgaya TM, Sayda AS. Paralytic lagophthalmos syndrome in the plastic and maxillofacial surgeon practice. STOMATOLOGII︠A︡ 2016; 95:58-61. [PMID: 27636764 DOI: 10.17116/stomat201695458-61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE to identify and give an objective assessment of all changes in the periorbital region in paralysis orbicularis oculi muscle. METHODS With physical, laboratory and instrumental methods of research, we analyzed the survey of 33 patients with paralytic lagophthalmos. This survey has allowed us to identify the symptoms of periorbital changes characteristic of paralysis orbicularis oculi involved in lagophthalmos development. RESULTS After analyzing the results of a survey of 33 patients with paralytic lagophthalmos, we identified 15 symptoms of changes in the periorbital region. CONCLUSION In our opinion, lagophthalmos should be considered as a syndrome, including certain symptom in a particular case. For adequate closure of the optic fissure and obtaining a good aesthetic result is necessary to simultaneously remove more of the symptoms.
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Affiliation(s)
- A I Nerobeev
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - Ts M Shurgaya
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A S Sayda
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Abstract
Facial nerve paralysis is a devastating condition arising from several causes with severe functional and psychological consequences. Given the complexity of the disease process, management involves a multispecialty, team-oriented approach. This article provides a systematic approach in addressing each specific sequela of this complex problem.
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Affiliation(s)
- Ali Razfar
- Division of Facial Plastic and Reconstructive Surgery, Center for Facial Cosmetic Surgery, University of Michigan School of Medicine, 19900 Haggerty Hwy, Livonia, MI 48152, USA
| | - Matthew K Lee
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, CA, 94305 USA
| | - Guy G Massry
- Ophthalmic Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, 9401 Wilshire Blvd., Suite 650, Beverly Hills, CA 90212, USA
| | - Babak Azizzadeh
- Department of Head and Neck Surgery, Center for Advanced Facial Plastic Surgery, David Geffen School of Medicine, University of California, Los Angeles, 9401 Wilshire Blvd., Suite 650, Beverly Hills, CA 90212, USA.
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Hasmat S, Lovell NH, Eviston T, Ekmejian R, Suaning GJ, Clark J. Creating eye closure in patients with facial nerve paralysis using an implantable solenoid actuator. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:1357-1360. [PMID: 26736520 DOI: 10.1109/embc.2015.7318620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper proposes the use of an implantable solenoid actuator to create a more natural eyelid closure over current lid loading therapies in patients with facial nerve paralysis (FNP). The actuator works by moving a magnet when a solenoid is activated. This is used to tension a sling applied to the upper eyelid which closes the eye. The sling design has been described elsewhere and creating eye closure using it requires a force of 627 (± 128) mN over a movement of approximately 6 mm. The actuator described here was able to successfully achieve these parameters and repeatedly perform eyelid closure in a cadaveric rabbit model. Device limitations and future improvements have also been identified and discussed.
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Wambier SPF, Garcia DM, Cruz AAV, Messias A. Spontaneous Blinking Kinetics on Paralytic Lagophthalmos After Lid Load with Gold Weight or Autogenous Temporalis Fascia Sling. Curr Eye Res 2015; 41:433-40. [PMID: 26016510 DOI: 10.3109/02713683.2015.1031252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the upper eyelid kinematics during spontaneous blinking in unilateral paralytic lagophthalmos before and after upper eyelid load with gold weight (GW) or autogenous temporalis fascia (TF) sling. DESIGN Comparative case series. SUBJECTS Patients with long-standing unresolved unilateral facial palsy who underwent surgical treatment with GW (n = 8) or upper lid cerclage with TF (n = 10). The contralateral eyelid served as the control for each patient (control group). METHODS Preoperative and postoperative measurements of spontaneous blink kinematics with magnetic search coil and clinical assessment of lid margin position, lagophthalmos and ocular surface exposure, and determine amplitude, maximum velocity and main sequence of spontaneous blinks; relative amplitude of blinks to the pupil center; ocular surface exposure scores; magnitude of lagophthalmos and mid-pupil lid distances. RESULTS The mean (±SE) down-phase amplitude ratio between paralyzed and contralateral eyelids (blink gain) was 10.0% preoperatively for both groups and significantly increased to 29 ± 6% for the GW group (p < 0.05) and 23 ± 4% for the TF group (p < 0.05). At 6 months the gain was significant for the GW group only (32 ± 7%, p < 0.05). There was no effect on the maximum velocity of the blinks or the main sequence of paretic and contralateral blinks with either surgery. Both procedures lowered the lid margin increasing the number of blinks that reached the pupil center. At 6 months this effect was prominent only for the GW group. Exposure keratopathy scores and lagophthalmos decreased postoperatively especially in the GW group. CONCLUSIONS The beneficial effect of lid load surgeries result from a combination of a small increase on the spontaneous blink amplitude and a static effect due to the reduction of the distance between the lid margin and pupil center.
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Affiliation(s)
- Sarah P F Wambier
- a Department of Ophthalmology , Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , Sao Paulo , Brazil and
| | - Denny M Garcia
- a Department of Ophthalmology , Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , Sao Paulo , Brazil and.,b Craniofacial Research Support Center, University of São Paulo , Sao Paulo , Brazil
| | - Antonio A V Cruz
- a Department of Ophthalmology , Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , Sao Paulo , Brazil and.,b Craniofacial Research Support Center, University of São Paulo , Sao Paulo , Brazil
| | - Andre Messias
- a Department of Ophthalmology , Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , Sao Paulo , Brazil and
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Abstract
Current options for correction of paralytic lagophthalmos are either temporary (external eyelid weight placement, hyaluronic acid gel or botulinum toxin A injection) or permanent (various procedures for narrowing of the palpebral fissure, upper eyelid weights or spring implantation). Neuroplastic surgery (cross-facial nerve grafting, nerve anastomoses) and muscle transposition surgery is not effective enough. The majority of elderly and medically compromised patients should not be considered for such complicated and long procedures. Upper eyelid weight implantation thus appears the most reliable and simple treatment.
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Affiliation(s)
- N S Iskusnykh
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
| | - Y O Grusha
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, Chair of Eye Diseases, Bolshaya Pirogovskaya St. 2-4, Moscow, Russian Federation, 119991
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Treatment of migration and extrusion of the gold weight eyelid implant with fascia lata sandwich graft technique. J Craniofac Surg 2015; 26:e10-2. [PMID: 25565227 DOI: 10.1097/scs.0000000000001221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Gold weight implantation is generally considered a safe procedure for the treatment of paralytic lagophthalmos. The most frequently seen complications are extrusion, malpositioning, and migration of the implant. To decrease the rate of these complications, several modifications were defined in the composition and the shape of the implant as well as the surgical technique itself. Despite these precautions, implant revision rates are still as high as 8% to 14%. Nowadays, implant-covering or implant-wrapping procedures are becoming more popular to avoid implant-related problems. However, there is limited information in the literature regarding the management of these complications. In this study, we aimed to present the treatment of migration and extrusion of the gold weight implant in a patient with Moebius syndrome by wrapping the implant with autogenous fascia lata graft.
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