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Prospective Evaluation of Eyelid Function With Gold Weight Implant and Lower Eyelid Shortening for Facial Paralysis
Douglas B. Chepeha, MD, MSPH;
John Yoo, MD;
Catherine Birt, MD;
Ralph W. Gilbert, MD;
Joseph Chen, MD
Arch Otolaryngol Head Neck Surg. 2001;127:299-303.
Objectives To assess which signs and symptoms were relieved by gold weight implantation
and which signs and symptoms persisted.
Design Prospective observational cohort.
Setting Tertiary care neurotology and oncology center.
Patients Sixteen (4 males and 12 females) consecutive patients whose average
age was 56 years (age range, 31-76 years). Inclusion criteria were gold weight
implant, lagophthalmos of 2 mm or more, and a House-Brackmann score of 3 or
less at the completion of follow-up. Mean follow-up was 13 months.
Interventions Each patient received a gold weight implant. Six of these patients underwent
a lower eyelid procedure.
Main Outcome Measures Surgical complications, static and dynamic lagophthalmos, static and
dynamic corneal coverage, visual acuity, keratitis, topical treatment, and
patient satisfaction.
Results There were no extrusions. The preoperative mean lagophthalmos was 7.5
mm and the postoperative mean was 0.5 mm, (P<.001).
Corneal coverage with eye closure before implantation was 73% and after implantation
was 100%, (P<.001). Corneal coverage with normal
(reflex) blink was less than 50% in 9 of 14 patients. When wearing correction,
no patients had 20/20 visual acuity. The mean patient satisfaction score before
the procedure was 3.5 and after was 7.1, (P<.001).
Patient satisfaction was most closely related to visual acuity. The relationship
was linear and statistically significant (P<.04).
Conclusions Gold weight implantation provides significant reduction in lagophthalmos
and significant improvement in corneal coverage. But owing to delayed closure
time and disrupted tear film, irritation may persist. As a result, some patients
require ongoing topical treatment of the eye, which can compromise visual
acuity.
From the Departments of Otolaryngology, University of Michigan Medical
Center, Ann Arbor (Dr Chepeha), London Health Sciences Centre, University
of Western Ontario, London (Dr Yoo), University of Toronto, Sunnybrook and
Women's College Health Science Centre, North York, Ontario (Drs Birt, Gilbert,
and Chen).
Corresponding author: Douglas B. Chepeha, MD, University of Michigan,
Department of Otolaryngology, 1904 Taubman Center, 1500 E Medical Center Dr,
Ann Arbor, MI 48109-0312 (e-mail: dchepeha{at}umich.edu).
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Arch Otolaryngol Head Neck Surg. 2001;127(3):342-343.
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