Long-term comparison of a newly designed gold implant with the conventional implant in facial nerve paralysis

Patients with complete facial nerve palsy are at risk for eye complications resulting from exposure of the cornea and loss of the blinking reflex. Fai lure of protection predisposes the patient to exposure keratitis, corneal a brasion and, in rare cases, blindness. The mainstays of nonsurgical therapy are cumbersome, obscure vision, and are mostly helpful in patients with ac ute facial paralysis in whom recovery of orbicularis oculi function is expe cted.,Methods of lid-loading using metal implants and gold eyelid weights h ave been reported in the literature. Between October of 1988 and March of 1995, 32 patients with lagophthalmos d ue to facial nerve palsy underwent a total of 34 procedures for the inserti on of a gold eyelid weight Each patient had a gold weight inserted into a s mall pocket between the orbicularis oculi and the tarsal plate of the upper eyelid. The gold implant is curved to fit the curvature of the eye and con tains holes for fixation to the tarsus with sutures. Ingrowth of fibrous ti ssue through the holes may also help fix the weight in position. Between 19 88 and 1991, 10 patients received 10 commercially available rectangular gol d implants with 2 holes; these implants resulted in adverse effects, such a s infection and exposure in up to 30 percent of the cases. Because of the h igh complication rate with the rectangular gold implant, the authors began using a new, elliptical gold implant with 3 holes, which is longer, thinner , wider in the tenter, and narrower in the peripheral portion. This new ell iptical implant was used on 22 patients (24 implants) from December of 1991 through March of 1995. The mean follow-up time for the 32 patients in the study tvas 41.3 months (range, 6 to 63 months), 49.8 months for patients wi th rectangular implants and 32.8 months for patients with elliptical implan ts. The elliptical gold implant resulted in dynamic closure of the eyelid a nd in excellent protection and cosmesis. Lagophthalmos and exposure keratitis resolved, visual acuity significantly improved without complications, and most patients could dispense with eyedr ops and salves. A lower eyelid supporting procedure (conchal cartilage graf t) should be performed simultaneously in patients with lagophthalmos of a m oderate or severe degree to achieve complete closure of the eyelid. Use of a tall pillow decreased the incidence of eyelid opening during sleep. Doubl e eyelid fold operations were performed on the contralateral eyelid after 6 months, resulting in a symmetrical and beautiful eyelid.