Temporal galeal fascia cover of custom-made gold lid weights for correction of paralytic lagophthalmos: long-term evaluation of an improved technique

• Published in: Journal of cranio-maxillo-facial surgery Vol. 29; no. 6; pp. 355 - 359
• Main Authors: Tremolada, C., Raffaini, M., D'Orto, O., Gianni, A.B., Biglioli, F., Carota, F.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-12-2001; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Blepharoptosis - etiology; Chronic Disease; Dentistry; Diseases of eyelid, conjunctiva and lacrimal tracts; Eyelid Diseases - rehabilitation; Eyelid Diseases - surgery; Facial Paralysis - rehabilitation; Facial Paralysis - surgery; Fascia - transplantation; Female; Follow-Up Studies; Gold Alloys; Humans; Longitudinal Studies; Male; Medical sciences; Middle Aged; Ophthalmology; Patient Satisfaction; Postoperative Complications; Prostheses and Implants; Prosthesis Design; Reproducibility of Results; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Suture Techniques; Temporal Muscle; Treatment Outcome; Xerophthalmia - prevention & control; Human; Performance evaluation; Gold; Nervous system diseases; Motor system disorder; Treatment efficiency; Facial paralysis; Facial nerve; Lagophthalmos; Weight; Symptomatology; Eye disease; Cranial nerve disease; Treatment; Eyelid disease; ENT disease; Adult; Complication; Application method; Technique; Upper eyelid
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1054/jcms.2001.0250

Background: Chronic paralytic lagophthalmos is a condition that is often conservatively treated with ophthalmic ointments and eye drops, but usually requires definitive surgical correction. Purpose: An effective modification of the gold lid loading technique is described, which we have found to be the simplest and most reliable method for lid reanimation. Material: After empiric evaluations with lead fisherman's weights ‘glued’ to the eyelid, a custom-made gold lid weight is made by a jeweller on the basis of the tarsal dimensions of the individual patient, and then sutured to the tarsus under local anaesthesia and covered with a fine sheet of temporal galea. Other ancillary procedures (lower lid suspension, lateral tarsal strip, lateral tarsoplasty) are added as required. Methods: Between 1990 and 1996, 27 patients underwent this type of surgery, of whom 24 were re-evaluated after a mean follow-up period of 73.2 months (range 36–96 months), 14 of these for a minimum of 5 years. Results: None of the gold weights was extruded, all 24 patients experienced marked improvement of their dry-eye symptoms and expressed a high degree of satisfaction. Six patients underwent further minor surgery (lateral McLaughlin tarsorrhaphy) in order to improve relative underaction. Two patients had ptosis (less than 2 mm of asymmetry) of the affected side but refused further correction. Conclusion: The use of custom-made gold lid weights and a protective galeal layer is a simple, reliable and successful means for permanently rehabilitating paralysed eyelids.