DOI: 10.1097/01.prs.0000304319.22504.47
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PMID: 18349638
Issn Print: 0032-1052
Publication Date: 2008/04/01
Encasement of a Gold Weight with Dermal Fat Graft in the Management of Paralytic Lagophthalmos
Excerpt
Patients with facial nerve palsy are at risk for serious eye complications, including keratitis, corneal abrasion and, in rare cases, blindness resulting from lagophthalmos. Surgical management of paralytic lagophthalmos has evolved tremendously to include tarsorrhaphies, canthoplasties, palpebral springs, silicone slings, eyelid magnets, and upper lid loading.1 Since Sheehan first described a new concept based on the force of gravity by placing a stainless steel mesh in the upper eyelid in 1927,2 a variety of implant materials involving gold weight and platinum chain have been used in the management of lagophthalmos. The use of gold eyelid weight was first reported by Illig in 19583 and has become a standard procedure over the years. In this technique, gold implant in the most appropriate weight and size is placed between the orbicularis oculi and the tarsal plate through a supratarsal fold incision. Migration, extrusion, and becoming visible under the skin as a result of thinning the overlying tissues (we call it the “silhouette deformity”) are the most common complications, and wound infection, excessive ptosis, and residual lagophthalmos are less seen.4 Various techniques including suture fixation,5 newly designed elliptical gold implants,1 and some autogenous or allogenous encasement materials such as temporal fascia6 and processed human pericardium7 have been used to address these complications. In this article, we propose a new method using a familiar autologous tissue, dermal fat graft, as a barrier to prevent or manage the complications of paralytic lagophthalmos.
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