Immediate reversible rehabilitation of the paralyzed eyelid

Management of inflammatory complications of skull base surgery

Because the contents of the intracranial cavity are exposed to the upper airway, inflammatory complications are the most frequent in skull base surgery. If dura has to be resected and reconstructed with a graft, the risk of inflammatory complications increases. An evaluation of 93 patients with skull base tumors who were operated on at the University of California, Davis Medical Center between July 1982 and March 1992 and had resection and reconstruction of dura is presented. Inflammatory complications developed in 33 (35%) patients. Local wound infection, cerebrospinal fluid leak, and meningitis are by far the most frequent complications. Patients with middle and combined fossae approaches have the highest incidence. Cause, treatment, and prophylaxis of inflammatory complications are discussed.

Early versus late gold weight implantation for rehabilitation of the paralyzed eyelid

OBJECTIVES/HYPOTHESIS

The purpose of this study is to evaluate the outcomes and complications associated with early gold weight implantation for management of the paralyzed eyelid.

STUDY DESIGN

A retrospective review of clinical charts was conducted to analyze results and complications in patients who underwent gold weight implantation within 30 days of onset of facial nerve paralysis and to compare these outcomes with those of patients who received gold weights after a traditional waiting period.

METHODS

The charts of 67 patients who underwent gold weight implantation during the time period of this study were reviewed. Patients were categorized into "early" or "late" groups based on whether gold weights were implanted before or after 30 days following onset of facial nerve paralysis. Etiology of facial nerve paralysis, degree of paralysis, timing of surgery, and outcomes of the procedure, including degree of lid closure and complication rates, were compared between the two groups.

RESULTS

Of the 67 patients, 49.3% underwent gold weight implantation within 30 days of onset of paralysis and 50.7% received gold weights after 30 days. A total of 89.2% of all patients who underwent implantation in this study achieved satisfactory lid closure after the initial procedure. Both early and late implantation groups had statistically similar lid closure and complication rates.

CONCLUSIONS

Implantation of gold weights within 30 days of paralysis is as effective for the management of paralytic lagophthalmos as delayed implantation and is not associated with higher complication rates. Early implantation of gold weights should be considered in all patients with paralytic lagophthalmos.