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CC BY 4.0 · Arch Plast Surg 2024; 51(02): 163-168
DOI: 10.1055/s-0043-1777287
Pediatric/Craniomilofacial/Head & Neck
Original Article

Implantation of a Newly Designed Supratarsal Gold Weight versus the Traditional Pretarsal Model for the Correction of Long-standing Paralytic Lagophthalmos: A Retrospective Cohort Study

Natthiya Lailaksiri 
1   Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
,
Pawarit Wanichsetakul 
2   Department of Ophthalmology, Faculty of Medicine, Thammasat University, Bangkok, Thailand
,
Preamjit Saonanon 
1   Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Abstract

Background The study determined to compare the clinical outcomes of traditional gold weight implantation for the correction of paralytic lagophthalmos with those of a newly designed model.

Methods In this retrospective cohort study, we enrolled 30 patients (76% females; average age 60.8 ± 12 years) with facial palsy who underwent implantation of either the traditional pretarsal gold weight (PT group; n = 15) or a new supratarsal model (ST group; n = 15) from May 2014 to April 2019. The main outcome measures were the 12-month postoperative weight prominence, weight migration, improvement of lagophthalmos, upper eyelid contour, and upper eyelid ptosis. The secondary outcome was long-term (24 months) reoperative rate.

Results The new model group had significantly better eyelid contour (risk ratio [RR] 3.16, 95% confidence interval [CI] 1.62–6.15, p = 0.001), less weight prominence (RR 1.74, 95% CI 1.13–2.70, p = 0.013), less weight migration (RR 1.31, 95% CI 1.12–1.54, p = 0.001), and less eyelid ptosis (RR 2.36, 95% CI 1.21–4.59, p = 0.011) than the traditional model group. Improvement of lagophthalmos was not statistically significant between the two groups (RR 1.44, 95% CI 0.72–2.91, p = 0.303). The 24-month reoperative rate was 53.3% in the PT group versus 13.3% in the ST group (RR 2.00, 95% CI 1.15–3.49, p = 0.015).

Conclusion The newly designed supratarsal gold weight showed superior postoperative outcomes than the standard traditional model.

Keywords

lagophthalmos - facial palsy - lid load - gold weight implantation - supratarsal implantation

Authors' Contributions

N.L.: study design, data collection, data analysis, data interpretation, writing—original draft, manuscript preparation


P.W.: implant design, data collection, review and editing in material part of manuscript


P.S.: study design, data interpretation, writing—review and editing manuscript, supervision


All authors read and approved the final manuscript.


All the authors were involved in the design of the study; the collection, analysis, and interpretation of data; and the writing and reviewing of the manuscript.


Ethical Approval

This study was approved by the Institutional Review Board and Ethics Committee, Faculty of Medicine, Chulalongkorn University. The study adhered to the tenets of the Declaration of Helsinki.


Patient Consent

Written informed consent was obtained from the author.


Note

This is an original manuscript. No plagiarism, fabrication, or falsification was involved in the writing of this paper.




Publication History

Received: 21 June 2023

Accepted: 24 October 2023

Article published online:
29 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Garcia RM, Hadlock TA, Klebuc MJ, Simpson RL, Zenn MR, Marcus JR. Contemporary solutions for the treatment of facial nerve paralysis. Plast Reconstr Surg 2015; 135 (06) 1025e-1046e
    CrossrefPubMedGoogle Scholar
  • 2 Allen RC. Controversies in periocular reconstruction for facial nerve palsy. Curr Opin Ophthalmol 2018; 29 (05) 423-427
    CrossrefPubMedGoogle Scholar
  • 3 Rofagha S, Seiff SR. Long-term results for the use of gold eyelid load weights in the management of facial paralysis. Plast Reconstr Surg 2010; 125 (01) 142-149
    CrossrefPubMedGoogle Scholar
  • 4 Bladen JC, Norris JH, Malhotra R. Indications and outcomes for revision of gold weight implants in upper eyelid loading. Br J Ophthalmol 2012; 96 (04) 485-489
    CrossrefPubMedGoogle Scholar
  • 5 Seiff SR, Sullivan JH, Freeman LN, Ahn J. Pretarsal fixation of gold weights in facial nerve palsy. Ophthal Plast Reconstr Surg 1989; 5 (02) 104-109
    CrossrefPubMedGoogle Scholar
  • 6 Kim YS, Hwang K. Shape and size of tarsal plates. J Craniofac Surg 2016; 27 (02) 496-497
    CrossrefPubMedGoogle Scholar
  • 7 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 (06) 1624-1634
    CrossrefPubMedGoogle Scholar
  • 8 Caesar RH, Friebel J, McNab AA. Upper lid loading with gold weights in paralytic lagophthalmos: a modified technique to maximize the long-term functional and cosmetic success. Orbit 2004; 23 (01) 27-32
    CrossrefPubMedGoogle Scholar
  • 9 Mavrikakis I, Malhotra R. Techniques for upper eyelid loading. Ophthal Plast Reconstr Surg 2006; 22 (05) 325-330
    CrossrefPubMedGoogle Scholar
  • 10 Rozen S, Lehrman C. Upper eyelid postseptal weight placement for treatment of paralytic lagophthalmos. Plast Reconstr Surg 2013; 131 (06) 1253-1265
    CrossrefPubMedGoogle Scholar
  • 11 Schrom T, Wernecke K, Thelen A, Knipping S. [Results after lidloading with rigid gold weights–a meta-analysis]. Laryngorhinootologie 2007; 86 (02) 117-123
    PubMedGoogle Scholar
  • 12 Saleh GM, Mavrikakis I, de Sousa JL, Xing W, Malhotra R. Corneal astigmatism with upper eyelid gold weight implantation using the combined high pretarsal and levator fixation technique. Ophthal Plast Reconstr Surg 2007; 23 (05) 381-383
    CrossrefPubMedGoogle Scholar
  • 13 Siah WF, Nagendran S, Tan P, Ali Ahmad SM, Litwin AS, Malhotra R. Late outcomes of gold weights and platinum chains for upper eyelid loading. Br J Ophthalmol 2018; 102 (02) 164-168
    CrossrefPubMedGoogle Scholar
  • 14 Ben Artsi E, Ullrich K, Brusasco L, Malhotra R. Long-term outcomes of upper eyelid loading with platinum segment chains for lagophthalmos: an adjustable approach. Am J Ophthalmol 2020; 214: 188-195
    CrossrefPubMedGoogle Scholar
  • 15 Berghaus A, Neumann K, Schrom T. The platinum chain: a new upper-lid implant for facial palsy. Arch Facial Plast Surg 2003; 5 (02) 166-170
    CrossrefPubMedGoogle Scholar
  • 16 Malhotra R, Ziahosseini K, Poitelea C, Litwin A, Sagili S. Platinum segments: a new platinum chain for adjustable upper eyelid loading. Br J Ophthalmol 2015; 99 (12) 1680-1685
    CrossrefPubMedGoogle Scholar
  • 17 Oh TS, Min K, Song SY, Choi JW, Koh KS. Upper eyelid platinum weight placement for the treatment of paralytic lagophthalmos: a new plane between the inner septum and the levator aponeurosis. Arch Plast Surg 2018; 45 (03) 222-228
    Article in Thieme ConnectPubMedGoogle Scholar