Facial Plast Surg 2000; 16(4): 325-336
DOI: 10.1055/s-2000-15548
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Reanimation of the Paralyzed Eyelid with the Enhanced Palpebral Spring or the Gold Weight: Modern Replacements for Tarsorrhaphy

Robert E. Levine1 , Jonathan P. Shapiro2
  • 1Department of Ophthalmology, USC School of Medicine, and House Ear Clinic, Los Angeles, CA
  • 2Department of Ophthalmology, Mount Sinai Medical Center, New York, NY
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Publikationsverlauf

Publikationsdatum:
31. Dezember 2000 (online)

ABSTRACT

The enhanced palpebral spring and the gold weight are the modern devices that should nearly completely replace tarsorrhaphy in the management of ocular problems secondary to facial paralysis. They actually reanimate the lid, rather than merely hold the lids closed in a disfigured position, as does tarsorrhaphy. The surgical techniques of each procedure, results, and pros and cons of each are compared. Personal experience with over 1400 spring implantations is discussed, as is experience with the use of bandage contact lenses in lieu of lid surgery. The gold weight implantation is simpler to learn and perform than the enhanced spring procedure, in which the levator is tightened in addition to implanting the spring. However, when it is really important to close the eye well, the spring is the superior procedure. Unlike the weight, the spring closes the eye well in the supine position, such as when the patient sleeps.

REFERENCES

  • 1 Smellie G D. Restoration of the blinking reflex in facial palsy by simple lid-load operation.  Bri J Plast Surg . 1966;  19 279
  • 2 Jobe R P. A technique for lid loading in the management of the lagophthalmos of facial palsy.  Plast Reconstr Surg . 1974;  53(1) 29-32
  • 3 O'Connell J E, Robin P E. Eyelid gold weights in the management of facial palsy.  J Laryngol Otol . 1991;  105(6) 471-474
  • 4 Canady J W, Meine J, Thompson S A, Yuh W T. Effects of magnetic resonance imaging fields on gold eyelid loads.  Ann Plast Surg . 1993;  31(1) 76-77
  • 5 Gardner T A, Rak K M. Magnetic resonance imaging of eyelid springs and gold weights.  Arch Ophthalmol . 1991;  109(11) 1498
  • 6 Kartush J M. MRI not contraindicated following gold or spring implantation to the upper eyelid for facial reanimation.  Am J Otol . 1991;  12(5) 398
  • 7 Abell K M, Baker R S, Cowen D E, Porter J D. Efficacy of gold weight implants in facial nerve palsy: quantitative alterations in blinking.  Vision Res . 1998;  38(19) 3019-3023
  • 8 May M. Gold weight and wire spring implants as alternatives to tarsorrhaphy.  Arch Otolaryngol Head Neck Surg . 1987;  113(6) 656-660
  • 9 Sobol S M, Alward P D. Early gold weight lid implant for rehabilitation of faulty eyelid closure with facial paralysis: an alternative to tarsorrhaphy.  Head Neck . 1990;  12(2) 149-153
  • 10 Keen M S, Burgoyne J D, Kay S L. Surgical management of the paralyzed eyelid.  Ear Nose Throat J . 1993;  72(10) 692,659-701
  • 11 Handler L F, Galetta S L, Wulc A E. Facial paralysis: diagnosis and management. In: Bosniak S, ed. Principles and Practice of Ophthalmic Plastic and Reconstructive Surgery Philadelphia: WB Saunders Company 1996: 465-483
  • 12 Kelley S A, Sharpe D T. Gold eyelid weights in patients with facial palsy: a patient review.  Plast Reconstr Surg . 1992;  89(3) 436-440
  • 13 Seiff S R, Sullivan J H, Freeman L N, Ahn J. Pretarsal fixation of gold weights in facial nerve palsy.  Ophthal Plast Reconstr Surg . 1989;  5(2) 104-109
  • 14 Townsend D J. Eyelid reanimation for the treatment of paralytic lagophthalmos: historical perspectives and current applications of the gold weight implant.  Ophthal Plast Reconstr Surg . 1992;  8(3) 196-201
  • 15 Seiff S R, Chang Jr S J. The staged management of ophthalmic complications of facial nerve palsy.  Ophthal Plast Reconstr Surg . 1993;  9(4) 241-249
  • 16 De Min G, Babighian S, Babighian G, Van Hellemont V. Early management of the paralyzed upper eyelid using a gold implant.  Acta Otorhinolaryngol Belg . 1995;  49(3) 269-274
  • 17 Kartush J M, Linstrom C J, McCann P M, Graham M D. Early gold weight eyelid implantation for facial paralysis.  Otolaryngol Head Neck Surg . 1990;  103(6) 1016-1023
  • 18 Gilbard S M, Daspit C P. Reanimation of the paretic eyelid using gold weight implantation. A new approach and prospective evaluation.  Ophthal Plast Reconstr Surg . 1991;  7(2) 93-103
  • 19 Pickford M A, Scamp T, Harrison D H. Morbidity after gold weight insertion into the upper eyelid in facial palsy.  Br J Plast Surg . 1992;  45(6) 460-464
  • 20 Neuman A R, Weinberg A, Sela M. The correction of seventh nerve palsy lagophthalmos with gold lid load (16 years experience).  Ann Plast Surg . 1989;  22(2) 142-145
  • 21 Ueda K, Harii K, Yamada A, Asato H. A comparison of temporal muscle transfer and lid loading in the treatment of paralytic lagophthalmos.  Scand J Plast Reconstr Surg Hand Surg . 1995;  29(1) 45-49
  • 22 Jobe R. Gold lid loads.  Plast Reconstr Surg . 1993;  91(3) 563-564
  • 23 Cies W A. Modified gold weights for reanimation of the upper lid in facial nerve paralysis.  Ophthal Plast Reconstr Surg . 1993;  9(3) 214-217
  • 24 Bair R L, Harris G J, Lyon D B, Komorowski R A. Noninfectious inflammatory response to gold weight eyelid implants.  Ophthal Plast Reconstr Surg . 1995;  11(3) 209-214
  • 25 Morel-Fatio D, Lalardrie J P. Palliative surgical treatment of facial paralysis: the palpebral spring.  Plast Reconstr Surg . 1964;  33 446
  • 26 Morel-Fatio D, Lalardrie J P. [The palpebral spring. Contribution to the study of plastic surgery of facial paralysis] [French].  Neuro-Chirurgie . 1965;  11(4) 303-310
  • 27 Morel-Fatio D. [The eyelid spring] [French].  Annales de Chirurgie Plastique . 1967;  12(1) 51-60
  • 28 Guy C L, Ransohoff J. The palpebral spring for paralysis of the upper eyelid in facial nerve paralysis: technical note.  J Neurosurg . 1968;  29(4) 431-433
  • 29 Levine R E, House W F, Hitselberger W E. Ocular complications of seventh nerve paralysis and management with the palpebral spring.  Am J Ophth . 1972;  73(2) 219-228
  • 30 Levine R E. Care of the eye in facial paralysis. In: Brackmann DE, Shelton C, Arriaga MA, eds. Otologic Surgery Philadelphia: WB Saunders 1994: 717-740
  • 31 Levine R E. The enhanced palpebral spring. In: Operative Techniques Plast Reconstruct Surg 1999 6(3): 152-156
  • 32 May M. Surgical rehabilitation of facial palsy. In: May M, ed. The Facial Nerve New York: Thieme 1986: 695-777
  • 33 May M, Levine R E, Patel B CK, Anderson R L, Schaitkin B M. Eye Reanimation Techniques in The Facial Nerve, 2d. In: May ed. New York: Thieme-Stratton Inc.; 2000: 677-774
  • 34 May M. Paralyzed eyelids reanimated with a closed-eyelid spring.  Laryngoscope . 1988;  98(4) 382-385
  • 35 Cartwright M J, Frueh B R. Evaluation and clinical significance of the mechanical properties of various palpebral springs.  Ophth Plast Recon Surg . 1995;  11(1) 1-15
  • 36 Rougier J, Demilliere B, Marin. [Treatment of palpebral inocclusion by the MorelFatio palpebral spring] [French].  Bulletin des Societes d Ophtalmologie de France . 1965;  65(5) 488-490
  • 37 Perrin C. [Facial paralysis surgically treated by nerve graft and palpebral spring] [French].  Journal Francais d Oto-Rhino-Laryngologie, Audio-Phonologie et Chirurgie . 1969;  18(5) 330
  • 38 English F P, English K P. The palpebral spring in facial palsy.  Med J Australia . 1972;  1(5) 223-225
  • 39 Morgan L R, Rich A M. Four years' experience with the Morel-Fatio palpebral spring.  Plast Recon Surg . 1974;  53(4) 404-409
  • 40 McNeill J I, Oh Y H. An improved palpebral spring for the management of paralytic lagophthalmos.  Ophthalmology . 1991;  98(5) 715-719
  • 41 Levine R E, Pulec J L. Eyelid reanimation with the palpebral spring after facial nerve graft surgery: an interdisciplinary approach.  ENT J . 1993;  72(10) 686-691
  • 42 Levine R E. The three R's of initial eye care in facial paralysis: re-wet, restore, and re-close. In: Update on Facial Nerve Disorders Alexandria, VA: American Academy of Otolaryngology-Head & Neck Foundation, Inc.; 2001: 267-275
  • 43 Levine R E. The three R's of long-term eye care in facial paralysis: restore, re-animate, and rehabilitate with the palpebral spring. In: Update on Facial Nerve Disorders Alexandria, VA: American Academy of Otolaryngology-Head & Neck Foundation, Inc.; 2001
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