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DOI: 10.5999/aps.2017.01599
Upper eyelid platinum weight placement for the treatment of paralytic lagophthalmos: A new plane between the inner septum and the levator aponeurosis
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Background The most common surgical treatment for paralytic lagophthalmos is the placement of a weight implant in the upper eyelid; however, this technique confers the risks of implant visibility, implant extrusion, and entropion. In this study, we present a new technique of placing platinum weight implants between the levator aponeurosis and inner septum to decrease such complications.
Methods A total of 37 patients with paralytic lagophthalmos were treated between March 2014 and January 2017 with platinum weight placement (mean follow-up, 520.1 days). After dissecting through the orbicularis oculi muscle, the tarsal plate and levator aponeurosis were exposed. The platinum weights (1.0–1.4 g) were fixed to the upper margin of the tarsal plate and placed underneath the orbital septum.
Results Five patients could partially close their eye after surgery. The average distance between the upper eyelid and the lower eyelid when the eyes were closed was 1.12 mm. The rest of the patients were able to close their eye completely. Three patients patient developed allergic conjunctivitis after platinum weight insertion, which was managed with medication. None of the patients complained of discomfort in the upper eyelid after surgery. Visibility or extrusion of the implant were observed in three patients.
Conclusions Postseptal weight placement is a safe and reproducible method in both primary and secondary upper eyelid surgery for patients with paralytic lagophthalmos. It is a feasible method for preventing implant visibility, implant exposure, and entropion. Moreover, platinum is a better implant material than gold because of its smaller size and greater thinness.
The article was presented at the PRS Korea 2015 on November 13-15, 2015 in Seoul, Korea.
Publication History
Received: 25 October 2017
Accepted: 12 February 2018
Article published online:
03 April 2022
© 2018. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
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REFERENCES
- 1 Rozen S, Lehrman C. Upper eyelid postseptal weight placement for treatment of paralytic lagophthalmos. Plast Reconstr Surg 2013; 131: 1253-65
- 2 Choi HY, Hong SE, Lew JM. Long-term comparison of a newly designed gold implant with the conventional implant in facial nerve paralysis. Plast Reconstr Surg 1999; 104: 1624-34
- 3 Silver AL, Lindsay RW, Cheney ML. et al. Thin-profile platinum eyelid weighting: a superior option in the paralyzed eye. Plast Reconstr Surg 2009; 123: 1697-703
- 4 Baheerathan N, Ethunandan M, Ilankovan V. Gold weight implants in the management of paralytic lagophthalmos. Int J Oral Maxillofac Surg 2009; 38: 632-6
- 5 Tan ST, Staiano JJ, Itinteang T. et al. Gold weight implantation and lateral tarsorrhaphy for upper eyelid paralysis. J Craniomaxillofac Surg 2013; 41: e49-53
- 6 Mclaughlin CR. Surgical support in permanent facial paralysis. Plast Reconstr Surg (1946) 1953; 11: 302-14
- 7 Illig KM. A new method of lagophthalmos surgery. Klin Monbl Augenheilkd Augenarztl Fortbild 1958; 132: 410-1
- 8 Berghaus A, Neumann K, Schrom T. The platinum chain: a new upper-lid implant for facial palsy. Arch Facial Plast Surg 2003; 5: 166-70
- 9 Amer TA, El-Minawi HM, El-Shazly MI. Low-level versus high-level placement of gold plates in the upper eyelid in patients with facial palsy. Clin Ophthalmol 2011; 5: 891-5
- 10 Lessa S, Nanci M, Sebastia R. et al. Treatment of paralytic lagophthalmos with gold weight implants covered by levator aponeurosis. Ophthal Plast Reconstr Surg 2009; 25: 189-93
- 11 Bianchi B, Ferri A, Leporati M. et al. Upper eyelid platinum chain placement for treating paralytic lagophthalmos. J Craniomaxillofac Surg 2014; 42: 2045-8
- 12 Bladen JC, Norris JH, Malhotra R. Cosmetic comparison of gold weight and platinum chain insertion in primary upper eyelid loading for lagophthalmos. Ophthal Plast Reconstr Surg 2012; 28: 171-5
- 13 Wagh VK, Lim WS, Cascone NC. et al. Post-septal upper eyelid loading for treatment of exposure keratopathy secondary to non-cicatricial lagophthalmos. Orbit 2016; 35: 239-44