LID GOLD WEIGHS IN THE TREATMENT OF PALPEBRAL INCOMPETENCE BECAUSE FACIAL NERVE PARALYSIS

Presently publication presented our experience in the treatment of palpebraL incompetence because of the facial nerve paralysis by means of gold weight superior lid implantation.

We described the form of election of the precise weight, as well as the surgical technique, and our experience in 18 patients treated in the last two years:

11 patients (61,1%) had good functional and aesthetic results; 3 (16,6%) had good functional, but not aesthetic- palpebral ptosis - improvement; and 4 (22,2%) need gold wieght remotion due to exposure and/ or muscle elevator fatigue.

We considered that an adequate valuation of the precise weight, keeping in mind the muscle elevator phenomenon and the lapsed time from the instauration of the paralysis should offer an better rate of successes.

The palpebral affectation in the facial nerve paralysis is a severe entity from the aesthetic and functional point of view.

The facial paralysis that affects to the orbicular muscle of the lids produces inability to close the eyph denominated lagoftalmos (of the Greek "lagos" that it means hare, animal that sleeps with the open eyes). Due to the orbicular muscle tone loss it takes place a eversión of the inferior lid (ectropion). The palpebral incompetence, the ectropion of the inferior lid and the alteration in the flow, drainage and lachrymal secretion that takes place in the facial paralysis, sometimes causes exposition keratitis, conjunctivitis, corneal ulcers, etc.

To correct and to avoid the ocular problems caused by the incompetence palpebral in the facial paralysis they have intended different therapeutic modalities. One of these therapeutic techniques it is based on the increase of the superior lid load using inside implant weigh of gold.

The placement of load inside the superior lid makes that the lid falls for its own weight and occlude completely the palpebral fissure. The elevator muscle of the superior lid, non inervated for the facial nerve, conquers the resistance to this weight and it is able to elevate the lid.

After the patient's detailed study (etiology of the facial paralysis, affectation degree, time of evolution, lachrymal function study, elevator muscle function study, previous surgeries, possibility of complementary surgeries, etc) and once suitable the installation of the weight should make a presurgical study where we will determine the anatomical conformation and the weigh from the to implant sheet.

Surgical technique:

Local palpebral infiltration anesthesia.

10 mm cutaneous incision parallel to the palpebral free border.

Orbicular muscle incision.

Pretarsal pocket under the orbicular muscle.

Introduction of the weight of gold in the pretarsal space.

Weight fixation to the tarsus (non reabsorbible suture) at 2-3mm of the free border of the lid.

Muscular and cutaneous planes close.

Patient with left complete facial paralysis after acoustic nerve neurinoma surgery . Important ocular symptomatology, with slight ectropion of the inferior lid and palpebral incompetence. The patient only wants to solve the ocular problems. We have implanted 1gr weight. Good aesthetic and functional results are obtained. The slight ptosis doesn't interfere the vision

Right complete facial paralysis after IV ventricle tumor (astrocitoma) surgery. Palpebral incompetence and paralyzed ectropion. Subjected to implantation of 0,7 gr gold weight in lid right superior and Kúhn-Szimanosky lagophtalmos technique inferior lid surgery.

The appropriate weight (bend and borders) conformation, the good material tolerance, the fixation to the tarsus, and the pretarsal plane weight placement contributes to the absence of complications (extrusion, exhibition, displacement, etc).

Our experience in 18 patients treated in the last two years shows that 11 patients (61,1%) had good functional and aesthetic results; 3 (16,6%) had good functional, but not aesthetic (palpebral ptosis) improvement; and 4 (22,2%) need gold wieght remotion due to exposure and/ or muscle elevator fatigue.