Experience with the gold weight and palpebral spring in the management of paralytic lagophthalmos.
BACKGROUND
The loss of the blink reflex and the ability to close the eye actively are disabling functional and aesthetic impairments common to patients with facial paralysis. Nonphysiologic (static) management techniques involve implantation of devices in the upper eyelid that mechanically aid eye closure. The most popular devices are the gold weight and the palpebral spring. The authors' experience with these devices is presented.


METHODS
Thirty-nine patients treated for paralytic lagophthalmos by the senior author (J.K.T.) between 1987 and 2002 met the inclusion criteria. Eighteen patients received the gold weight and 21 received the palpebral spring. From standardized video records, preoperative and postoperative blink scores were calculated.


RESULTS
Fifty-nine percent of the patients (23 of 39) were female, and the most common cause for facial paralysis [35.9 percent (14 of 39)] was extirpation of acoustic neuroma and other cerebellopontine lesions. Fifty percent of the gold weight cohort was younger than 20 years at the time of surgery, with almost 40 percent (seven of 18) younger than 10 years. In the palpebral spring group, 14.3 percent (three of 21) were younger than 20 years, with 4.8 percent (one of 21) younger than 10 years. The palpebral spring group obtained a larger postoperative mean blink score of 34.0 +/- 12.4 percent compared with the gain of 21.4 +/- 14.6 percent (p = 0.025) by the gold weight group.


CONCLUSIONS
The gold weight and palpebral spring are both effective in restoring motion to the paretic upper eyelid, but the palpebral spring is more so despite the frequent need for revisions.
Terzis
Julia K
JK
Norfolk, Va. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Eastern Virginia Medical School, and the International Institute of Reconstructive Microsurgery.
Kyere
Sampson A
SA
D000293:Adolescent; D000328:Adult; D019882:Blepharoplasty / Q000379:methods*; D002648:Child; D005143:Eyelids / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D006046:Gold; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D012189:Retrospective Studies
D006046:Gold