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Aronson S, Applebaum SA, Kelsey LJ, Gosain AK. Evidence-Based Practices in Facial Reanimation Surgery. Plast Reconstr Surg 2023; 152:520e-533e. [PMID: 37647378 DOI: 10.1097/prs.0000000000010539] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the causes and preoperative evaluation of facial paralysis. 2. Discuss techniques to restore corneal sensation and eyelid closure, elevation of the upper lip for smile, and depression of the lower lip for lip symmetry. 3. Outline treatment goals, surgical treatment options, timing of repair, and other patient-specific considerations in appropriate technique selection. SUMMARY Congenital facial paralysis affects 2.7 per 100,000 children; Bell palsy affects 23 per 100,000 people annually; and even more people are affected when considering all other causes. Conditions that impair facial mimetics impact patients' social functioning and emotional well-being. Dynamic and static reconstructive methods may be used individually or in concert to achieve adequate blink restoration, smile strength and spontaneity, and lower lip depression. Timing of injury and repair, patient characteristics such as age, and cause of facial paralysis are all considered in selecting the most appropriate reconstructive approach. This article describes evidence-based management of facial paralysis.
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Affiliation(s)
- Sofia Aronson
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Sarah A Applebaum
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Lauren J Kelsey
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Arun K Gosain
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
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Orbicularis Oculi Muscle Reinnervation Confers Corneal Protective Advantages over Static Interventions Alone in the Subacute Facial Palsy Patient. Plast Reconstr Surg 2020; 145:791-801. [PMID: 32097327 DOI: 10.1097/prs.0000000000006608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Corneal protection is a priority in flaccid facial palsy patients. Denervation of the orbicularis oculi muscle results in weak palpebral closure and predisposes patients to severe corneal sequelae. While periorbital static procedures enhance corneal coverage in repose, voluntary closure is only regained through dynamic reinnervation of the muscle. This study aims to elucidate the added effect of dynamic reinnervation of the orbicularis oculi muscle on long-term corneal integrity as well as on dynamic closure of the palpebral aperture. METHODS Retrospective review was performed on two groups of complete palsy patients: those who received solely periorbital static procedures and those who underwent concomitant orbicularis oculi muscle reinnervation and static lid procedures. Only patients with complete ophthalmic examinations were included. Corneal punctate epithelial erosions in addition to static and dynamic palpebral measurements were serially assessed preoperatively and postoperatively. RESULTS Of 272 facial palsy patients, 26 fit the inclusion criteria. Eleven patients underwent combined muscle reinnervation involving facial-to-masseteric nerve coaptation in addition to static eye procedures, and 15 patients underwent solely static interventions. Analysis revealed a 65.3 percent lower mean punctate epithelial erosion score in reinnervation patients as compared with static patients when evaluated at more than 9 months postoperatively (p < 0.01). Reinnervation patients were also found to have 25.3 percent greater palpebral aperture closure (p < 0.05) and 32.8 percent higher closure velocity (p < 0.01) compared with static patients. CONCLUSION In patients with subacute facial palsy, dynamic reanimation of the orbicularis oculi muscle with concomitant static interventions provides lasting corneal protection not seen in patients who receive solely static interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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A Modified Technique of Transposition of Temporalis Muscle in Selected Cases of Longstanding Facial Paralysis. J Craniofac Surg 2019; 31:e1-e4. [PMID: 31403508 DOI: 10.1097/scs.0000000000005804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The authors present a modified technique of temporalis muscle transposition technique in cases of longstanding facial paralysis. Slips of the temporalis fascia were passed through the tunnels to reach the contralateral para-median plane. The procedure provides 2 point of fixation to the transferred muscle. Local flaps were used for temporal hollow obliteration and for temporalis muscle elongation.This case series included 11 patients. The modified technique was performed for all patients to reanimate the lower face while gold weight impanation in the upper eye lid was used for re-animation of the eye in 9 patients. By the end of follow up, the procedure was considered successful in 9 patients. Eight patients expressed their satisfaction and 7 patients were happy with the regained facial movement.The modified temporalis muscle transfer technique might be a valuable option in cases of longstanding facial paralysis. The lips would be camouflaged, non-stretched and would move with the whole mid-face.
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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
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Egemen O, Ozkaya O, Uscetin I, Akan M. Covering the gold weight with fascia lata graft in paralytic lagopthalmos patients. Br J Oral Maxillofac Surg 2012; 50:369-72. [DOI: 10.1016/j.bjoms.2011.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/19/2011] [Indexed: 11/30/2022]
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Experience with the Gold Weight and Palpebral Spring in the Management of Paralytic Lagophthalmos. Plast Reconstr Surg 2008; 121:806-815. [DOI: 10.1097/01.prs.0000299919.18076.b4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pirrello R, D'Arpa S, Moschella F. Static treatment of paralytic lagophthalmos with autogenous tissues. Aesthetic Plast Surg 2007; 31:725-31. [PMID: 17694252 DOI: 10.1007/s00266-007-0074-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 04/03/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-standing facial paralysis is frequently seen in patients who have undergone surgical procedures with sacrifice of the facial nerve and have never been counseled about limiting its consequences. Lagophthalmos must always be treated in these patients to protect vision. The authors describe their techniques of static treatment for lagophthalmos using autologous tissues and their classification system for standardizing patients. METHODS From July 2001 to September 2005, 12 patients (9 men and 2 women) ranging in age from 37 to 77 years (mean, 58.5 years) were treated. Their paralysis was attributable to acoustic neuroma resection in seven cases, to resection of a cerebral vascular anomaly in two cases, and to total parotidectomy with facial nerve sacrifice in three cases. The patients were treated with elongation of the levator palpebrae superioris muscle using a fascia lata graft, bolstering of the lower eyelid with a conchal cartilage graft, or both, combined with a Kuhnt type resection when needed. RESULTS Complete closure was achieved for nine patients (75%). For all the patients, resolution of symptoms and keratitis was achieved. No complications were observed. The follow-up period ranged from 14 to 51 months (mean, 39.5 months). The cosmetic outcome also was satisfactory. CONCLUSIONS For candidates eligible to undergo static treatment of lagphthalmos, the techniques described may be considered valuable options for the correction of lagophthalmos using autologous tissues, thus avoiding the complications related to alloplastic material implantation.
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Affiliation(s)
- Roberto Pirrello
- Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Universitá di Palermo, Via del Vespro, 129, 90138 Palermo, Italy
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Lavy JA, East CA, Bamber A, Andrews PJ. Gold weight implants in the management of lagophthalmos in facial palsy. ACTA ACUST UNITED AC 2004; 29:279-83. [PMID: 15142076 DOI: 10.1111/j.1365-2273.2004.00817.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The otolaryngologist plays an essential role in the diagnosis and management of a facial palsy. We present one of the largest cohort prospective studies in the UK of 22 patients with gold weight implants, including ancillary oculoplastic techniques, and their outcomes. Facial paralysis places the eye at risk and protection and lubrication of the eye is paramount in the management of these patients. If recovery of facial function is likely to be delayed or negligible, gold weight loading of the upper lid has been shown to be effective in providing a dynamic solution to lagophthalmos. Following surgery, complete eye closure was possible in the upright position in 18 patients (82%). Two patients had their weights removed secondary to infection (9%). At long-term follow up, four patients judged their vision to have deteriorated (29%). Two of these, after investigation by the ophthalmologists, were found to have pressure astigmatism and removal corrected the visual problems. Overall patient satisfaction with the procedure is high and all reported improvement in eye closure following the operation. An algorithm for the management of the eye in patients with facial palsy is outlined.
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Affiliation(s)
- J A Lavy
- Royal National Throat, Nose & Ear Hospital, Gray's Inn Road, London, UK
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Abstract
Patients with lagophthalmos are often treated with a stock gold weight that has been implanted in the upper eyelid. This relatively simple surgical technique does not, however, always produce the desired result. This article describes a technique for the fabrication of a custom eyelid implant prosthesis for patients who present with a non-functioning and unaesthetic eyelid implant.
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Affiliation(s)
- Mijin Choi
- Restorative Department, Baltimore College of Dental Surgery, University of Maryland, USA
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Caesar RH, Friebel J, McNab AA. Upper lid loading with gold weights in paralytic lagophthalmos: a modified technique to maximize the long-term functional and cosmetic success. Orbit 2004; 23:27-32. [PMID: 15513017 DOI: 10.1076/orbi.23.1.27.28994] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
PURPOSE To describe a modified fixation technique to improve the long-term functional and cosmetic success of upper lid loading with gold weights. METHOD A retrospective single surgeon study of combined upper pre-tarsal and direct levator fixation of the gold weight. The minimum follow-up period was 12 months. RESULTS Gold weights were implanted with the modified technique into 29 patients. The gold weight was removed in two cases due to infection and in one case due to ptosis. There was no loss of function over the follow-up period and the cosmetic outcome was good or very good in all cases. The follow-up ranged from 12 to 84 months with a mean of 40 months. CONCLUSIONS Combined upper pre-tarsal fixation and direct levator fixation is effective in maximizing both the long-term functional and cosmetic success of upper lid loading with gold weights in paralytic lagophthalmos.
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Affiliation(s)
- R H Caesar
- Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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Abstract
A modified surgical procedure for temporalis transfer in facial reanimation of five consecutive cases is presented. Instead of the traditional stripping of the temporalis from its origin, its attachment at the coronoid removed, and to its end, the harvested fascia lata graft was sutured to lengthen the muscle's action. These fibres were then passed to the Orbicularis Oculi and Oris to aid in reanimation and to improve their tone. The procedure is less extensive, provides a direct line of pull with good functional results, no muscle atropy since vascularity and innervation is maintained. No complaints of paresthesia, hyposthesia or scar on donor leg was noticed. None of the patients required a revision of surgery for unacceptable contour or asymmetry. This simple procedure has helped reconstruction of natural symmetrical smile with highly successful results.
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Affiliation(s)
- S M Balaji
- Balaji Dental & Craniofacial Hospital, 30 Kavingar Bharadidasan Road, Teynampet, Chennai-600 018, S. India.
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12
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Special feature: Treatment alternatives for postsurgical and posttraumatic facial reanimation. Curr Opin Otolaryngol Head Neck Surg 2001. [DOI: 10.1097/00020840-200108000-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Harrisberg BP, Singh RP, Croxson GR, Taylor RF, McCluskey PJ. Long-Term Outcome of Gold Eyelid Weights in Patients With Facial Nerve Palsy. Otol Neurotol 2001; 22:397-400. [PMID: 11347647 DOI: 10.1097/00129492-200105000-00022] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of upper eyelid gold weight implants in managing paralytic lagophthalmos and to compare two surgical techniques for their insertion. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. PATIENTS One hundred four patients had a gold weight implanted for paralytic lagophthalmos between 1982 and 1996 at the Royal Prince Alfred Hospital in Sydney. Each patient had more than 2 years of follow-up of lid load function. MAIN OUTCOME MEASURES The effectiveness of gold weights in reanimating eyelid closure, mean duration of gold weight retention, reasons for removal, and complications resulting from a gold weight; these outcomes were also compared using two surgical techniques for gold weight insertion. RESULTS One hundred three patients maintained corneal integrity. At the time of assessment, 46 patients had had their lid loads removed from their eyelids, and 58 lid loads remained in situ. Of the lid loads that were removed, 78% were because the facial nerve had recovered. The remaining 22% were removed because of cosmetic dissatisfaction (7 patients), the lid load becoming too superficial (6 patients), migration (3 patients), partial extrusion (1 patient), and ptosis resulting from too heavy a weight (1 patient). CONCLUSION Gold weights are well tolerated and effective in managing paralytic lagophthalmos. An open surgical technique with direct suture fixation of the gold weight to the tarsal plate produced fewer complications than inserting the lid load into a prefashioned tissue pocket in the preseptal space through a small lateral skin incision.
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Affiliation(s)
- B P Harrisberg
- Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, Australia
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14
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Abstract
PURPOSE A prospective before-and-after trial was designed to evaluate the role of upper-lid gold weight implantation and lower lid lateral canthoplasty in the management of patients with paralytic lagophthalmos. PATIENTS AND METHODS The study included 40 patients (age range 19 to 72, mean age 46.8), and gold weights varying from 0.6 to 1.6 g were implanted in all 40 patients. Lateral canthoplasty was performed in 14 of the patients who suffered from variable degrees of lower lid laxity. Mean follow-up period was 15.7 months (range 9 to 38). RESULTS Complete correction of lagophthalmos and/or ectropion with resolution of preoperative symptoms was achieved in 37 of 40 patients (92.5%), and spontaneous extrusion of the gold weight occurred in only one patient (2.5%). CONCLUSION Excellent results were achieved in the management of paralytic lagophthalmos with upper-lid gold weight insertion, and simultaneous lateral canthoplasty proved to be very helpful in patients with significant hypotonia of lower lid.
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Affiliation(s)
- H M Foda
- Department of Otolaryngology-Head and Neck Surgery, Alexandria Medical School, Egypt
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15
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Julian GG, Hoffmann JF, Shelton C. Surgical Rehabilitation Of Facial Nerve Paralysis. Otolaryngol Clin North Am 1997. [DOI: 10.1016/s0030-6665(20)30164-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Spector JG. Neural repair in facial paralysis: clinical and experimental studies. Eur Arch Otorhinolaryngol 1997; 254 Suppl 1:S68-75. [PMID: 9065632 DOI: 10.1007/bf02439728] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Acute facial nerve injuries involving the total facial nerve (n = 202) and its segmental branches (n = 63) were repaired with a variety of neural (n = 225) and myofascial transfer (n = 40). A system for evaluating results based on facial symmetry and tone at rest, recovery of voluntary mimetic activity, synkinesis, and recovery of selective function in discrete facial nerve divisions is presented. The best results were achieved with immediate direct end-to-end neural-epineural anastomotic repairs. The least favorable results were seen with myofascial transpositions and long extratemporal rerouted autologous nerve grafts. A series of tissue culture and animal experiments were used to examine structural changes in neural repair. The requirements for successful motoneuron regeneration, causes of synkinesis and methods for nerve stump coaptation are elucidated. Tubulation experiments demonstrated the need for neurotrophic and neuropromotive factors. Problems associated with the use of autologous nerve grafts are discussed.
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Affiliation(s)
- J G Spector
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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Otto RA. Restoration of function in the paralyzed rabbit orbicularis oculi muscle by direct functional electrical stimulation. Laryngoscope 1997; 107:101-11. [PMID: 9001273 DOI: 10.1097/00005537-199701000-00020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Restoration of the ability to blink and protect the eye in the patient with facial paralysis remains a challenge. Although many treatments exist, no one approach corrects all the deficits associated with the loss of orbicularis oculi function. In this study, the author investigated the feasibility of restoring function by direct electrical stimulation of the paralyzed orbicularis oculi muscle in the rabbit model. Using a pacing device developed by the author, functional restoration of a normal-appearing blink was produced throughout 30 days of continuous pacing in six rabbits with transected facial nerves. Histologic evaluations of the paced tissues demonstrated no evidence of detrimental effects attributable to the electrical stimulation. The findings of this study support the feasibility of employing direct electrical stimulation to restore the function of paralyzed orbicularis oculi muscles. Potential applications may also exist in other areas in which peripheral denervation creates functional impairment.
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Affiliation(s)
- R A Otto
- Department of Otolaryngology, University of Texas Health Science Center, San Antonio 78284-6200, USA
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Biel MA. GORE-TEX graft midfacial suspension and upper eyelid gold-weight implantation in rehabilitation of the paralyzed face. Laryngoscope 1995; 105:876-9. [PMID: 7630304 DOI: 10.1288/00005537-199508000-00021] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M A Biel
- Minneapolis Ear Nose and Throat Clinic, MN 55404, USA
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Affiliation(s)
- F G Fedok
- Department of Surgery, Pennsylvania State University, Milton S. Hershey Medical Center, University Hospital-Children's Hospital, Hershey 17033, USA
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Catalano PJ, Bergstein MJ, Sen C, Post K. Management of the eye after iatrogenic facial paralysis. Neurosurgery 1994; 35:259-62; discussion 262-3. [PMID: 7969833 DOI: 10.1227/00006123-199408000-00011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The aesthetic and functional morbidity associated with facial palsy is significant. Fortunately, corneal exposure and ulceration with the potential for the loss of visual acuity can be minimized by eyelid procedures such as gold weight implantation and horizontal eyelid shortening. Although primarily designed for restoration of eyelid function, these procedures also improve ocular cosmesis. However, uncertainty remains regarding the indications for eyelid surgery: When should surgery be performed, in whom, and which procedure(s)? On the basis of our series of 60 patients evaluated for facial paralysis, guidelines for the management of the paralyzed eyelids after iatrogenic injury to the facial nerve are proposed.
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Affiliation(s)
- P J Catalano
- Department of Otolaryngology, Mount Sinai School of Medicine, New York, New York
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Maas CS, Benecke JE, Holds JB, Schoenrock LD, Simo F. Primary surgical management for rehabilitation of the paralyzed eye. Otolaryngol Head Neck Surg 1994; 110:288-95. [PMID: 8134139 DOI: 10.1177/019459989411000305] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Protection of the eye is the primary concern in managing the patient with facial paralysis; however, the aesthetic consequences cannot be overlooked. Lagophthalmos has traditionally been treated with frequent ocular lubrication, medical eye care, and tarsorrhaphy. This approach is fraught with the difficulties of poor patient compliance and unacceptable cosmesis. We suggest a protocol for the complete ocular management with emphasis on immediate rather than delayed surgical rehabilitation as a primary therapy in facial paralysis. Gold weight implantation to the upper lid and tightening of the lower lid at the lateral canthus are simple and reliable procedures that provide immediate functional and aesthetic improvement. This surgical technique has extremely low morbidity and is reversible should facial function return. We have used this protocol in more than 30 patients with excellent results.
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Affiliation(s)
- C S Maas
- Department of Otolaryngology, University of California, San Francisco 94117
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Abstract
Inability to close the eyelids (lagophthalmos) is a major problem for patients with facial paralysis. Various treatment modalities and combinations can be used to restore function and esthetics. Lid loading is an effective method of treatment and can be further enhanced by custom fabrication of the prosthesis. The dentist functions as an integral part of the treatment team, working with the plastic surgeon and ophthalmologist to achieve the most functional and esthetic result.
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Affiliation(s)
- M M Grisius
- University of Pennsylvania, School of Dental Medicine, Philadelphia
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Abstract
The most devastating sequelae of the facial nerve paralysis is the loss of eye lid function. The inability to blink, lubricate and protect the globe can lead to exposure keratitis, corneal abrasion and even the loss of vision. Eyelid closure is approximately 85% upper eyelid and 15% lower eyelid. In order to ensure adequate protection of the globe, deficiencies of both eyelids must be addressed. We report our experience with 20 patients with eyelid paralysis. Upper lid reanimation was performed by the placement of gold lid weights on the tarsal plate. Lower lid reanimation procedures included lateral canthopexy and horizontal lid shortening. A discussion of the above-mentioned procedures, the timing of the procedures and a critical analysis of results will be included. A comprehensive approach to the management of the paralyzed eye will be presented.
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Pickford MA, Scamp T, Harrison DH. Morbidity after gold weight insertion into the upper eyelid in facial palsy. BRITISH JOURNAL OF PLASTIC SURGERY 1992; 45:460-4. [PMID: 1393250 DOI: 10.1016/0007-1226(92)90210-o] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- M A Pickford
- RAFT Department of Research in Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex
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