1
|
Lowndes Correa Francalacci R, Lessa S, da Costa Aboudib JH. Auricular Cartilage Graft for Lengthening Levator Muscle Aponeurosis With Ectropion Correction for Paralytic Lagophthalmos. Aesthet Surg J 2023; 43:13-23. [PMID: 35788264 DOI: 10.1093/asj/sjac181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Paralytic lagophthalmos can have devastating consequences for vision if left untreated. Several surgical techniques have been described, including the utilization of alloplastic and autologous materials. OBJECTIVES The authors sought to evaluate the effectiveness of the surgical treatment of paralytic lagophthalmos with combined techniques employing autologous material and involving the upper and lower eyelids. METHODS Patients with paralytic lagophthalmos underwent stretching of the levator aponeurosis with interposition of conchal cartilage in the upper eyelid associated with sectioning of the orbitomalar ligament and lateral canthoplasty in the lower eyelid. The effectiveness of the technique was evaluated employing subjective (symptomatology) and objective parameters (ophthalmologic evaluation and measurements of lagophthalmos and marginal reflex distances 1 and 2). RESULTS Eight patients with paralytic lagophthalmos were subjected to the proposed technique. In the postoperative period, 85.7% reported complete improvement of symptoms and 62.5% presented a normal eye examination. The mean lagophthalmos measurement was reduced by 5.93 mm, the mean marginal reflex distance 2 was reduced by 2.61 mm, and the mean marginal reflex distance 1 was reduced by 0.69 mm. CONCLUSIONS The technique presented herein, employing autologous material associated with sectioning of the orbitomalar ligament and lateral canthoplasty, was effective in the treatment of paralytic lagophthalmos and did not present significant complications, such as extrusion. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
| | - Sérgio Lessa
- Postgraduate Program in Oculoplastic Surgery, State University of Rio de Janeiro, State University of Rio de Janeiro (UERJ), Rio de Janeiro-RJ, Brazil
| | - José Horácio da Costa Aboudib
- Postgraduate Program in Physiopathology and Surgical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro-RJ, Brazil
| |
Collapse
|
2
|
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
|
3
|
Siah WF, Nagendran S, Tan P, Ali Ahmad SM, Litwin AS, Malhotra R. Late outcomes of gold weights and platinum chains for upper eyelid loading. Br J Ophthalmol 2017; 102:164-168. [PMID: 28689170 DOI: 10.1136/bjophthalmol-2016-310089] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/16/2017] [Accepted: 05/27/2017] [Indexed: 11/04/2022]
Abstract
AIM To identify late outcomes of gold weights (GWs) and platinum chains (PCs) for upper eyelid loading in the management of lagophthalmos. METHODS A retrospective case series of upper eyelid GWs and PCs at a single centre over a 10-year period (2004-2013). Two independent, blinded assessors graded standard photographs for any weight-related morbidity (poor upper eyelid contour, weight prominence and migration). RESULTS Primary upper eyelid loading (high-tarsal technique) was performed in 154 eyelids of 136 patients (facial nerve palsy, n=99; non-paralytic, n=37). A total of 127 eyelids of 110 patients had primary GW insertion. Of these, 40.9% (52/127) had revision surgery: exchange of GW for PC (58%), GW repositioning (25%) and removal of GW (17%). Only 22.2% (6/27 eyelids) with primary PCs required revision surgery. In those not requiring revision surgery, photograph grading showed that both GWs and PCs had weight-related morbidity at late follow-up (median=37.5 months, range 12-110 vs median=33.5 month, range 15-106). GWs had significantly higher rate of weight prominence (p=0.001) and migration (p<0.001) compared with PCs. All PC revisions required one procedure only compared with 10% of GWs revisions requiring two or more procedures. Incidence of gold allergy was 7% (8/110 patients). There was no association between the choice of weight material, physical weight or suture material and eyelid morbidities. CONCLUSION GWs were found to be associated with higher complications and twice more likely to require long-term revision surgery compared with PCs. Despite weight fixation at a high-tarsal location, prominence of PCs can still occur.
Collapse
Affiliation(s)
- We Fong Siah
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Sonali Nagendran
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Western Sussex Hospitals NHS Trust, Worthing, West Sussex, UK
| | - Petrina Tan
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | | | - Andre S Litwin
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
| |
Collapse
|
4
|
Grusha YO, Fedorov AA, Iskusnykh NS, Bogacheva NV, Kobzova MV, Novikov IA, Fettser EI, Shchegoleva TA. [Gold weight implants for lagophthalmos correction in chronic facial nerve paralysis (late results)]. Vestn Oftalmol 2016; 132:26-32. [PMID: 27213794 DOI: 10.17116/oftalma2016132226-32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Upper eyelid weigh gold implant is the widely accepted standard for the treatment of paralytic lagophthalmos (PL). AIM To evaluate late outcomes of PL correction with chain gold implants. MATERIAL AND METHODS Chain gold implants were inserted in the upper eyelids of 70 patients with lagophthalmos due to chronic facial paralysis. A comprehensive ophthalmic examination was performed prior to surgery and then at months 1, 3, 6, 12, 24, and 36. RESULTS The results obtained prove the method highly effective. None of the patients developed any severe complications. Cases of implant removal were few. Some of the studied biometric parameters decreased significantly after surgery, while the upper eyelid excursion increased. The implant had no effect on the inner surface of the cornea and its peripheral thickness. CONCLUSION Efficacy of the proposed eyelid implant has been convincingly demonstrated; late complications have been analyzed.
Collapse
Affiliation(s)
- 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, Ophthalmology Department, 2 str. 4 Bol'shaya Pirogovskaya St., Moscow, Russian Federation, 119991
| | - A A Fedorov
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
| | - N S Iskusnykh
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
| | - N V Bogacheva
- Lomonosov Moscow State University, Faculty of Psychology, 1 Leninskie Gory, Moscow, Russian Federation, 119991
| | - M V Kobzova
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, Ophthalmology Department, 2 str. 4 Bol'shaya Pirogovskaya St., Moscow, Russian Federation, 119991
| | - I A Novikov
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
| | - E I Fettser
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
| | - T A Shchegoleva
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
| |
Collapse
|
5
|
Treating the Golden Implant Visibility on a Paralytic Eye by Using the Capsule Shield Technique. J Craniofac Surg 2015; 27:191-3. [PMID: 26703048 DOI: 10.1097/scs.0000000000002269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Static upper eyelid weight loading is a well known treatment option for patients who suffer from paralytic lagophtalmus. Golden implants may cause some complications such as extrusion, postoperative ptosis, visibility of the implant from the skin, infection, or dislocation. Our patients applied to our clinic with discomfort of the implant's easily noticeable visibility in their daily life. They were scheduled the operation programme for reducing visibility of implant.In operation, capsule formation has seen and dissection begun preserving the capsule formation. The capsule has opened on its cranial edge and implant has been removed. By this maneuver, 2 layers of capsule were dissected from surrounding tissues without separating its caudal edges from the upper tarsal fold. These 2 layers were sutured to each other providing strong fibrous shield with the aim of preventing implant visibility. A new pocket has been created under this fibrous shield.Capsule shield technique is provided to replace the implant and prevent revisibilation by using forceful fibrous and highly vascular 2 layers of capsule. This technique seems 1 step ahead than autogenous grafts that require secondary surgical area and bring donor site complications with itself. It does not contain any risk of developing foreign body response and graft infection, unlikely nonautogenous/autogenous graft materials. Also, in the capsule shield technique, operation duration will be shorter and hospitalization period will be shorter compared with techniques using barrier materials because it does not require any additional surgical intervention in donor area. In addition, the authors keep the apeuneurosis in anatomical position and no other new incisions are required. Since no biomaterials are required, this technique also avoids donor site morbidity.
Collapse
|
6
|
Deep Temporal Fascia Coverage of the Loading Weight in Paralytic Lagopthalmos Patients. J Craniofac Surg 2015; 26:1631-3. [DOI: 10.1097/scs.0000000000001861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
7
|
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.
Collapse
|
8
|
Vásquez LM, Medel R. Lagophthalmos after facial palsy: current therapeutic options. Ophthalmic Res 2014; 52:165-9. [PMID: 25342248 DOI: 10.1159/000365519] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 06/25/2014] [Indexed: 11/19/2022]
Abstract
As the facial nerve carries sensory, motor and parasympathetic fibres involved in facial muscle innervation, facial palsy results in functional and cosmetic impairment. It can result from a wide variety of causes like infectious processes, trauma, neoplasms, autoimmune diseases, and most commonly Bell's palsy, but it can also be of iatrogenic origin. The main ophthalmic sequel is lagophthalmos. The increased surface exposure increases the risk of keratitis, corneal ulceration, and potentially loss of vision. Treatment options are wide; some are temporary, some permanent. In addition to gold standard and traditional therapies and procedures, new options are being proposed aiming to improve not only lagophthalmos but also the quality of life of these patients.
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW Facial nerve paralysis has a profound impact on patients' quality of life, of which one of the most important sequelae is a risk of corneal surface disease. Herein, we discuss methods to protect the eye following insult to the facial nerve. RECENT FINDINGS Protection of the ocular surface in patients with facial nerve injury is of paramount importance to prevent corneal injury and potential blindness. Many interventions on the eye are temporary and therefore easily reversible. A systematic approach to managing the eye is required in these patients. SUMMARY This article provides a review of current methods used for ocular protection in patients with facial nerve paralysis.
Collapse
|
10
|
Coyle M, Godden A, Brennan PA, Cascarini L, Coombes D, Kerawala C, McCaul J, Godden D. Dynamic reanimation for facial palsy: an overview. Br J Oral Maxillofac Surg 2013; 51:679-83. [PMID: 23385066 DOI: 10.1016/j.bjoms.2012.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Abstract
Facial paralysis can have a profound effect on the patient from both an aesthetic and functional point of view. The symptoms depend on which branch of the nerve has been damaged and the severity of the injury. The purpose of this paper is to review currently available treatments for dynamic reanimation of a damaged facial nerve, and the goals are a symmetrical and coordinated smile. Careful selection of patients and use of the appropriate surgical technique can have excellent results.
Collapse
Affiliation(s)
- Margaret Coyle
- Department of Oral and Maxillofacial Surgery, North Bristol NHS Trust, Frenchay Hospital, Bristol BS16 1LE, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|